La consultation psychiatrique d’Yves Pélicier ou l’art de la biographie

The teaching and clinical practice of professor Yves Pélicier contributed to the international development of a psychiatry centered on the whole of the person in a humanist approach. The theoretical developments were marked by the authenticity of the practice of the therapist and its deep sense of the human being thus truly founding a School.     

Phenomenology of OCD: Lessons from a large multicenter study and implications for ICD-11

This study aimed to investigate the phenomenology of obsessive–compulsive disorder (OCD), addressing specific questions about the nature of obsessions and compulsions, and to contribute to the World Health Organization's (WHO) revision of OCD diagnostic guidelines. Data from 1001 patients from the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders were used. Patients were evaluated by trained clinicians using validated instruments, including the Dimensional Yale–Brown Obsessive–Compulsive Scale, the University of Sao Paulo Sensory Phenomena Scale, and the Brown Assessment of Beliefs Scale. The aims were to compare the types of sensory phenomena (SP, subjective experiences that precede or accompany compulsions) in OCD patients with and without tic disorders and to determine the frequency of mental compulsions, the co-occurrence of obsessions and compulsions, and the range of insight. SP were common in the whole sample, but patients with tic disorders were more likely to have physical sensations and urges only. Mental compulsions occurred in the majority of OCD patients. It was extremely rare for OCD patients to have obsessions without compulsions. A wide range of insight into OCD beliefs was observed, with a small subset presenting no insight. The data generated from this large sample will help practicing clinicians appreciate the full range of OCD symptoms and confirm prior studies in smaller samples the degree to which insight varies. These findings also support specific revisions to the WHO's diagnostic guidelines for OCD, such as describing sensory phenomena, mental compulsions and level of insight, so that the world-wide recognition of this disabling disorder is increased.     

Le « soi territorial » : propositions théoriques à partir d’une compréhension phénoménologique de la schizophrénie

ObjectivesThis theoretical paper discusses the integration of a “territorial self” alongside the minimal and narrative selves most commonly described by contemporary phenomenology and used by phenomenological psychopathology.MethodsWe start from the schizophrenic experience and the tools for understanding it, in order to highlight some limitations in the use of vocal communication within the clinical system to evoke phenomena that are a priori pre-linguistic.ResultsThis theoretical path, which requires an openness to clinical observation and intersubjectivity, leads to nosographic and therapeutic implications that seem useful to us from a phenomenological perspective.DiscussionFrom a nosographic standpoint, we discuss the (non-systematic) crossovers between the schizophrenic experience and the psychotic experience; whereas, from a therapeutic standpoint, the proposal of the territorial self allows us to insist on the fact that the clinical relationship is characterized as much by an analysis of experience and a discussion about it as it is by a joint practice and an experiential experience requiring a common ground.ConclusionsThe “territorial self” proves to be a fruitful and heuristic theoretical proposal, enriching nosographic debates in the field of psychosis, and contributing to a reflection on the practice of psychotherapy.     

Problem-based learning and clinical practice: The nurse practitioners’ perspective

This paper reports the findings of a phenomenological study which explored the lived experience of the nurse practitioner (NP) who had been educated through a problem-based learning (PBL) approach and the meaning of that education on the NPs current clinical practice. This was accomplished through the use of in-depth interviews to gather information from 13 practicing NPs. It was found that information obtained in the PBL classroom could be directly applied to professional practice providing the NP with the skills needed for clinical decision making with a holistic viewpoint and satisfaction in clinical practice. The analysis both supports and challenges the current research on perceptions, experiences, satisfaction, and outcomes related to PBL.     

A systematic review comparing clinical features in early age at onset and late age at onset late-life depression

Background

Although evidence suggests that there are neurobiological differences between unipolar depression in younger versus older adults, conflicting evidence exists about whether these manifest as clinically identifiable differences.

Method

We conducted a systematic review of aetiological, phenomenological and outcome studies to examine the evidence for a distinction between early onset (EOD) and late onset (LOD) depression. A literature search was completed using the computer databases MEDLINE, EMBASE, PSYCHINFO and PUBMED for papers published between January 1982 and December 2012 which compared groups with EOD and LOD. Studies were included if they were of older people and compared symptoms, aetiological factors or outcomes. We conducted a quality assessment of included articles.

Results

We identified 23 articles which met entry criteria. The only clinical feature which was different between the groups was a higher frequency of a family history of mood disorders in EOD.

Limitations

The number of studies identified was low and their quality was generally poor.

Conclusions

Although neurobiological studies have reported differences between EOD and LOD, generally these do not appear to translate into identifiable distinguishing clinical features.     

L’anorexie mentale : une fatigue de ne pas être soi ?

This article understands anorexia nervosa as a strategy for self-production, shaping the body in a certain way to achieve intersubjective recognition. More precisely, it would be a strategy to systematically achieve three objectives characteristic of modern social existence, where individuals are called upon to achieve themselves through their own resources, freeing themselves from any authority. Subjected to the injunction to be “someone”, and to achieve a remarkable individual performance, the anorexic subject would be singularly sensitive to the risks of failure that constitute these two social ideals. Thus, 1) thinness would allow the anorexic subject to avoid the question of his or her identity, by producing through the thin body a type of identity rather than a true subjectivity. Scared at the idea of not being able to define the borders and faculties of the “self”, the anorexic person would hide behind the type of identity suggested by a very slim appearance. 2) Working on their body, the anorexic subject would escape the hazards of conventional forms of work and self-actualization, by choosing a material – their own body – over which they have immediate power and which a priori only tests their will, by suppressing any external, unmanageable hazard. 3) Conscious of the social representations with which leanness is invested, the anorexic subject would control the kind of judgment made on them by others: they would thus escape the risk, normally structural, of not being recognized by the other conscious subjects, or of being misunderstood by them.     

L’abord phénoménologique de l’épistémologie de la psychiatrie,selon Georges Lantéri–Laura

ObjectiveThe article aims to give an account of the construction, by G. Lantéri–Laura, philosopher and historian of psychiatry, of a phenomenology of psychiatry dedicated to the critical elucidation of its foundations, inseparable from the concrete approach of its history, apprehended with the methods of structuralism.MethodThe stages of this construction are summarized and connected to the path of their author, while paying tribute to him and his work.ResultsThis phenomenology of the psychiatric fact privileges the study of the sign and its effects of meaning, and requires the clarification of the conditions of its production, including the knowledge and the know-how that it supposes. Extending the work of E. Minkowski thanks to the principles of structuralism, G. Lantéri–Laura considers the structure of the semiotics of psychiatry and makes numerous contributions to its semiology, notably of language. Considering the investigation of its praxis to be inseparable from its history, he forges a periodization of it in various paradigms, in conformity with T. Kuhn's epistemology and with C. Lévi–Strauss's conception of history.DiscussionLantéri–Laura links this phenomenology with an approach to subjectivity that keeps Husserl's vow of evidence, but without rejecting the unconscious, thus resisting the hegemonic and totalizing tendency of any psychopathology through the rigorous elucidation of the semiotics of psychiatry and the emphasis put on the regional, plural, and historical characters of its epistemology.ConclusionG. Lantéri–Laura has proposed a phenomenological epistemology of psychiatry, inseparable from the three dimensions of semiotics, subjectivity, and its history.