Vers un rapprochement du syndrome de Klinefelter et de la psychopathie en psychiatrie légale

Klinefelter syndrome (KS) (47,XXY) is the most common aneuploidy (1/650) of sexual chromosome among male (0,1 à 0,2 % of male population) (Hong and Reiss, 2014). Because its large physical phenotypic variability (high tall, sparse hairiness, gynecomastia), this syndrome is largely underdiagnosed (less than 25 % of affected persons) (Samango-Sprouse et al., 2018). Nevertheless, cognitive variability is smaller. Normal to low average total IQ, low verbal IQ, social problems and high levels of psychiatric comorbidities including early aggressiveness are commonly described (Hong and Reiss, 2014). In Denmark, higher risks of committing sexual crime and arson (compared to criminal controls) was recently reported (Stochholm et al., 2012). Quite a few clinically relevant cases reports scattered in the literature, suggests the presence of a pattern of a specific subtype of KS inpatients among forensic population (Bénézech, 1975). However, very few studies provide quantitative or qualitative pertaining to robust results. KS well-documented neurobiological (van Rijn, 2018) (e.g. low levels of testosterone), neuropsychological (Bénézech, 1975; Hong and Reiss, 2014; Samango-Sprouse et al., 2018; Savic, 2012; Seara-Cardoso et al., 2016; Senon, 2005; Stochholm et al., 2012; van Rijn, 2018; van Rijn et al., 2008; van Rijn et al., 2018; van Rijn et al., 2014; van Rijn et al., 2012) [29] (e.g. alterations of both complex cerebral — attention, empathy — and behavioral regulation functions - inhibition, mental flexibility, emotional response modulation, control of own actions) and neuroanatomical (Hong and Reiss, 2014; Itti et al., 2003; Savic, 2012; van Rijn et al., 2008; van Rijn et al., 2012) [29] (e.g. limbic system and temporal lobe abnormal volume, hemispheric specialization shortcoming) features may be helpful to understand comorbid symptoms psychopathology. Numbers of recent studies conduct on KS pediatric or adult population provide interesting results on conduct, anxiety, psychotic and autism spectrum disorders. In addition, some authors use genetic and epigenetic specific features of sex chromosome aneuploidies (e.g. X genes neurodevelopmental role; imprinting) in order to clarify genotype-phenotype links of comorbid symptoms (Bruining et al., 2011; Zitzmann et al., 2004;). With Belgian colleagues from the Social Defense Research Center (CRDS, Tournai, Belgium), we are currently recruiting KS inpatients from security hospitals or psychiatric units in Belgium and France. We aim to assess psychopathic traits with the Psychopathy Checklist Revised (PCL-R, Hare) (Hare, 2003). Our first results concerning 3 KS males outline that PCL-R is useful for the characterization of clinical phenotype among KS forensic sample. While three of them present psychopathic traits, two of them present categorical double diagnose “psychopathy-KS” (total PCL-R score > = 30/40 (Delannoy et al., 2017)). Moreover, dimensional analysis support our hypothesis of a higher prevalence of “explosive profile” in comparison to other psychopathic profiles in our sample (Delannoy et al., 2017). The present article summarizes historic background (e.g. “psychopathy” disappearance of mental disorder reference classification schemes, “crime chromosome” (Bénézech, 1975)) and current context argues (e.g. French psychiatrists court experts widely refer to psychopathy concept despite a lack of consensual definition (Senon, 2005), weak knowledge and training of PCL-R and its related biopsychological recent findings (Blair, 2013; de Oliveira-Souza et al., 2008; Dotterer et al., 2017; Glenn and Raine, 2014; Hosking et al., 2017; Korponay et al., 2017; Pham, 1995; Pham, 2005; Raine, 2008; Raine et al., 2003); stigma and discrimination apprehensions of KS and psychopath) that motivate our research project. Finally, we discuss the advantages of our research protocol on KS participants assessed with PCL-R, such as tackling stigma and discrimination, better understanding psychopathology, and clarifying murky interactions of biological, psychological and social factors entangled in the development of these two fascinating troubles.     

À propos de la psychiatrie de liaison en cancérologie

The psychiatrists practice in consultation-liaison psychiatry is peculiar. The work requires him/her to adapt to the terrain: to seize the opportunity of intervening in one way or another he will be obliged simultaneously to abandon his dual position with the patient, to integrate into the medical team and, also, to take into account the physiological specificity of the illness and its psycho-social repercussions. Whether on a formal or informal register all is subtle and delicate in these liaison interventions. Cancer and cancerology even add their own specificity and constraints to this mode of exercise. Consultation-liaison remains, more particularly in cancerology, a practice of mediation and of conciliation confronted to the problematics of risk, of incertitude and of finiteness.     

La psychothérapie de l'enfant : la symbolisation accompagnée

The psychotherapy of children may be carried out by psychiatrists and psychologists, but also by psychomotricians, language therapists, etc. It varies according to age, pathology, context, expectancies. Symptoms, language use, introspection capacities, capacities in various domains such as language, body expression, etc. are taken into account. Treatment is indicated according to each individual situation. Psychotherapy is conceived as a method for accompanying symbolisation. It is meant to help children use playing and creativity as methods of symbolisation. It does not aim at searching unconscious significations. Art therapy may now be used in the field of social interventions or teaching, as a way to reduce the violence of contemporary society.     

The Covid-19 infection: An opportunity to develop systematic vitamin D supplementation in psychiatry

Psychiatric patients are at risk of hypovitaminosis D and Covid-19-related mortality. In addition to the mental health benefits, vitamin D supplementation may be potentially effective in preventing severe forms of Covid-19 infections. Vitamin D supplementation is not necessary and is not reimbursed in France for this indication. A monthly supplementation of 50,000 IU may be sufficient in most cases. Double the dose is recommended for obese patients. The risk of renal lithiasis is not increased at these doses, even when supplemented in a patient without vitamin D deficiency. The Covid-19 crisis is an opportunity to disseminate vitamin D supplementation in psychiatric patients, as it has been shown to be effective in other respiratory diseases such as mild upper respiratory tract infections and influenza.     

Pierre Schützenberger (1888–1973) : un aliéniste,expert dans l’affaire des sœurs Papin (Partie I)

In Le Mans on 2 February 1933: Christine and Lea Papin murdered savagely their patroness Mrs Léonie Lancelin and her daughter, Geneviève, at their home. A trial that excited the whole of France and defrayed the chronicle. Pierre Schützenberger (1888–1973) was the head doctor at the mental asylum of Le Mans. The day after the crime, he was appointed as psychiatric expert. As a few weeks later, he shall be assisted in this task by Victor Truelle (1871–1938) and Jacques Baruk (1872–1975). Every two was alienists. The first was a head doctor at Sainte-Anne hospital in Paris and the second at Saint-Gemmes-sur-Loire asylum near Anger. The experts took the clear position of the absolute responsability of the defendants. A correspondence between Schützenberger and the psychiatrist Louis Le Guillant (1900–1968) allows us, on the one hand, to go behind the scenes of this expertise, which was vigorously challenged during and after the trial and, on the other hand, to situate it in the context of the 1930s. There was not a possible psychological analysis for P. Schützenberger in this case. As illustrated his non-published conference on freudism that was held on 9th March 1933. When reading one of this we note that he was very sceptical by the introduction of Psychoanalysis, which appeared to him to be a backward step compared with the French Somatical School's use of biological notions in Psychopathology.     

Transmettre à et pour des enfants en détresse. Observations à partir de films institutionnels autour de la Seconde Guerre mondiale

Questions of transmission have been addressed by psychiatrists through clinical film recordings since the pioneering work by René A. Spitz (1887–1974). These films screen child behavior in clinical situations exploring forms and structures of parent-child transmission. Departing from clinical teaching film addressed to professional audiences, the present contribution turns to films of universal distribution and in particular the film A child went forth by the American film director Joseph Losey (USA, 1940, 26 min), investigating transmission to and for children around WWII. An early expression of Losey's fascination with alternate perspectives of childhood and education, his documentary is sold to the US government and adapted to include security statements for families threatened by war. The film becomes a document of state information in a time where family structures could potentially be disrupted by mobilization or through non-return from war. The inquiry about the film invites a threefold level of analysis: first transmission to the children; second transmission between professionals; and third transmission to the general public referring to information and propaganda. In contrast to clinical teaching films recording children as patients, documentary film, as an object and as a vector addressed to a general public, opens another venue for observation and analysis of adult-child transmission from the widest possible perspective.     

Architecture,théorie du soin en psychiatrie et politique. De la forme au sens

When evoking the insane asylum, Esquirol wrote in 1822 : “In the hands of a skillful physician it is the most powerful agent against mental illnesses”, he did not refer only to the architectural space arrangement of the asylum but to its global conception of the care environment, and this notion of care environment is more complex than it seems. The significant link he introduced could lead to confuse that which belongs to care and that which depends on the environment in which it is given. Moreover, history shows this subtle exchange between psychiatry and architecture. Within the research of the therapeutic impact that an ideal society could have on mental illness, the link between moral treatment and the architecture of the classical asylum is well known as is that between the village hospital with institutional psychotherapy. But, on the other hand, who remembers that the debate between Marxism and psychoanalysis within psychiatry had important repercussions on the architectural and environmental modalities provided to care for the mentally ill ?     

Quel système pour quelle classification psychiatrique ? De Linné à Schotte en passant par le DSM et Szondi

Objective

The aim of this article is to define more clearly the different models of classification that have accompanied the history of psychiatry, which will situate the DSM better with regard to the models of classification that preceded it. This will also highlight the originality and interest of the nosographical conception proposed by Jacques Schotte.

Method

This article defends the idea that it is impossible to think about this question of classification without defining more fundamentally the epistemology on which the psychiatric practice is based. Distinguishing and classifying the philosophical systems such as Jules Vuillemin had done permits the better definition of these epistemologies and hence the type of classification that corresponds.

Results

Dogmatic naturalistic classifications are the classifications that medicine and psychiatry had inherited from Linné and Sydenham and that at a time when medicine was assimilated to botany: the diseases were described and defined as substances. The DSM-III represented a profound change in paradigm: attempting to be a-theoretical and limited to a consensus based on the statistics and opinion of the various editorial participants, the DSM was reduced to being a sceptical classification legitimate at a certain period in time and in certain areas. The originality of the works of Jacques Schotte was his attempt to establish a nosography that was neither dogmatic nor sceptical.

Discussion

Based on intuitional epistemology, Schotte's nosography avoids the classical naturalistic-type psychiatric models but also the sceptical model. Using this system, a diagnosis should be composed of psychiatric disorders as a ‘presentification’ and no longer as a ‘representation’. The diagnosis can no longer be detached from the thoughts of the therapist and from a therapeutic method.

Conclusions

The question of the classification of psychiatric pathologies runs throughout the history of the discipline. No classification appears satisfactory; the new version of the DSM only starts up old controversies. This problem of nosography only reflects the great epistemological confusion that prevails in the field of psychiatry. Through the bias of the classification of philosophical systems that distinguish the various epistemologies that are confronted by psychiatry, allows one to understand better in which way the classification models differ and improve our understanding of the interest of the works of Jacques Schotte on psychiatric nosography.