Le sommeil de l’analyste

The state of “nodding off” which the psychoanalyst may experience during therapy is a phenomenon that requires further investigation into its nature, causes, and effects. Even if it occurs only sporadically and is a physiological necessity, it nevertheless has a certain effect and can present certain advantages. This introduction of resistance in the form of sleep can sometimes provide an opportunity in the development of sensorimotor functions for the patient to verbalize his experience, and in any case this phenomenon should not be taken lightly. Recourse to current knowledge regarding sleep can improve our understanding of this phenomenon, and we should be prepared to take the risk of examining psychoanalysis on the basis of a non-analytical approach, i.e. primarily psychobiological and cognitive. This also permits a link to be made between the psychoanalyst’s therapeutic activity and the contextual phenomena which influence cerebral activity and its level of vigilance which is expressed by specific types of verbalization. The pertinence of this risk-taking should also be examined, and a distinction made between physiologically necessary somnolence and other causes. It appears that in the present context, the induction of a state of somnolence is caused by the narcissistic characteristics of a transferential relation that is in the process of development; that is to say, the “positive aspects’’ of narcissism, which are an integral part of psychic growth. However, we should also bear in mind that these narcissistic characteristics can also be expressed in the form of resistance.     

Facteurs associés au burnout en anesthésie–réanimation. Enquête 2009 de la Société française d’anesthésie et de réanimation

Objective

To assess factors related to burnout in anesthesia and intensive care.

Design

National prospective observational study.

Materials and methods

Questionnaire posted on the French Society of anesthesia website from 3rd June 2009 to 27th August 2009: Maslach Burnout Inventory (MBI), Fast Alcohol Consumption Evaluation (FACE) and The Harvard National Depression Screening Day Scale (HANDS) scales and questions to assess health, work and personal life.

Results

One thousand six hundred and three questionnaires returned: 1091 anesthetists (67.6%), 241 intensivists (14.9%), 204 nurses (12.6%), emergency physicians (2.8%), supervisor nurses (0.9%). Seven hundred and sixty three in a university hospital (47.3%), 259 in a regional hospital (16.1%), 405 in a private structure (25.1%), 71 in a non-lucrative private structure (4.4%), 75 in a military hospital (4.6%). Rest of safety: 69.2% of institutions. Depression: 38.7%. Drug or chemicals addicted: 10.6%. Alcohol addicts: 10.6%. Among them, 62.3% of individuals were in burnout. Burnout was linked to fragmented sleep (P < 0.00001), interpersonal conflicts (P < 0.00001), perception of rest of safety (P < 0.02), mental history (P < 0.00001), suicidal ideations (P < 0.00001), depression (P = 0.00001), alcohol (P < 0.002), drug consumption (P < 0.00002), and accidents after a nightshift (P < 0.05). Subjects in burnout intended more frequently to leave the profession (P < 0.00001). Leaving in couple had a protective effect (P < 0.005). The logistic regression model retained seven covariates independently associated with burnout: quality of work, of personal life, of fatigue, depression, conflicts with colleagues and patients, regretting the choice of specialty.

Conclusion

This study of the largest cohort of anesthesia personnel performed in France detects a high proportion of burnout. It highlights links with tensors that may constitute possibilities of prevention of the burnout syndrome.     

Nap polygraphic recordings after partial sleep deprivation the night before in epileptology pediatrics

Introduction

The relationship between sleep and epilepsy has been established since the antiquity and remains a subject of research in neurophysiology.

Methods

Nap electroencephalogram (EEG) after partial deprivation of sleep (ESPPS) the night before and the eve of the EEG after partial deprivation of sleep (EVPPS) was performed at the neurophysiology laboratory of the Sidi-Bel-Abbés University Hospital (Algeria). The series included 129 children with various types of epilepsy, aged between two and 15 years, whose standard EEG was normal (without sleep deprivation). Depending on the child's age, partial sleep deprivation was performed by the parents by beginning evening sleep late and early morning awakening. This recording procedure was performed in calm conditions and in a dark atmosphere using head electrodes.

Results

Activation (interictal paroxysms or non paroxysmal pathologic activity) was observed in 73% of patients after partial deprivation of night sleep. Ictal events were recorded in six patients.

Conclusion

This method was contributive to diagnosis in three-quarters of the patients. The EVPPS was more conclusive than the ESPPS. This fact demonstrated the usefulness of sleep deprivation for the exploration of electric abnormalities not detected by a standard EEG.     

Sleep circadian rhythm in rat kangaroo (Potorous apicalis): Effect of food distribution]

The influence of food distribution on circadian rhythm of sleep was studied by polygraphic methods in 4 adult Kangaroo Rats and in 3 young from 18 to 19 weeks old (at the weaning period). Experimentation was carried out during July and August. Animals were kept in isolation and in continuous light (LL) for 3 weeks; food was given every day by the experimenter between 7 and 8 p.m. and it was available ad lib; therefore, the tested factor presented characteristics of a brief and punctual signal. In the adult Potorous, we observed the persistency of alternate phases of activity and rest; and their periodicity coincided apporximately with that described in the light-dark schedule; that means an absence of phase change in the circadian rhythm of sleep in these animals. A decrement was observed in circadian variations of total sleep amount: an increase of both paradoxical and slow wave sleep percentages appeared during the subjective night of the animals. Young Potorous kept in (LL) from the 18th to the 21st week after birth, presented some perturbations in their sleep-wakefulness cycle similar to those observed in adult; but the young seem to answer individually to the periodic “food distribution” factor. The importance of food distribution for synchronizing biological rhythm in natural environmental conditions was discussed; and its determinant value as a signal was revealed.     

Effects of fasting on phasic phenomena of mouse's paradoxical sleep (author's transl)]

In C57Br/cd/Orl mice, the effects of water and/or food deprivation were considered in relation to weight, amounts of vigilance states, patterns of the peripheric phasic phenomena (eyes, whiskers and tongue movements) during paradoxical sleep. A 24 hr complete fasting provokes a loss of weight (?15%) a decrease in paradoxical sleep (?87%) and in slow wave sleep (?49%). While the frequency of the tongue movements during PS is not altered by fasting, the patterns of these movements are modified according to the experimental situation.     

Comment caractériser et traiter les plaintes de sommeil dans les troubles bipolaires ?

Objectives

Sleep complaints are very common in bipolar disorders (BD) both during acute phases (manic and depressive episodes) and remission (about 80 % of patients with remitted BD have poor sleep quality). Sleep complaints during remission are of particular importance since they are associated with more mood relapses and worse outcomes. In this context, this review discusses the characterization and treatment of sleep complaints in BD.