Troubles psychotiques révélateurs de maladie de Creutzfeldt-Jakob sporadique

The onset of the sporadic Creutzfeldt-Jakob disease is usually characterized by dementia or neurological symptoms. We are reporting the case of a 31 year-old man with a sporadic Creutzfeldt-Jakob disease characterized by a schizophrenia-like onset. The schizophrenic symptoms developed for sixteen months before the neurological symptoms appeared. The psychiatric onset of the present case was linked with the early age of onset and the long duration of the disease and could have been influenced by polymorphism of the codon 129 of the prion protein gene (PRNP) and a type of pathological prion protein (PrPres).     

Les formes psychiatriques de la maladie de Niemann-Pick de type C

Niemann-Pick type C disease diagnosed in adult neurology departments may be infantile or juvenile forms with prolongated life spans or forms starting at adolescence or adulthood. Psychomotor retardation is practically constant. In some cases, a psychosis may be the only manifestation for several years. The diagnosis is often made when extrapyramidal symptoms appear as well as cerebellar ataxia and ophtalmoplegia in the vertical gaze. The treatment with psychotropic drugs raises the question of a superimposition of a drug induced lipidosis. Hepatosplenomegaly is often discrete contrary to classical infantile cases. Foam cells as well as sea blue histiocytes are features of the disease. The filipin test evidences the lysosomal storage of cholesterol.     

Koinzidenz von schizophrener Psychose und Panikstörung mit Agoraphobie

The coincidence between panic disorder and depression is a well known phenomenon. However, only few studies investigated the coincidence of panic disorder with schizophrenia. This may in part be explained by the fact that both positive and negative symptoms of schizophrenia may mask the clinical symptoms of a panic disorder. We report on a female patient suffering both from agoraphobia with panic disorder and paranoid schizophrenia according to ICD-10. The productive psychotic symptoms responded well to treatment with a low dose of zotepine, whereas the panic disorder was effectively treated with a combined therapy with imipramine and cognitive behavioral therapy. Although it has to be questioned whether the coincidence between panic disorder and schizophrenia reflects two different diagnostic entities, the occurrence of symptoms of a panic disorder in schizophrenia deserve further attention because these may be treated efficiently by a specific pharmacotherapy and psychotherapy.     

Innocence et culpabilité pathologiques

Innocence and culpability are two realities of the experiment human at the same time paradoxical and contrary and capable of subtle intrications. After having approached the roots of these two great concepts in their historical concepts, we will be able to traverse the fields specific to each one of them. Innocence is very early in the history reported to the problems of the young children and their violent death to mean the values of a moral and spiritual nature thereafter. The culpability refers as of the Antiquity to the fault of the culprit and its crime to relate to later the transgressions of a particular group and of its rites. These considerations enable us to seize the specific fields well. Innocence is characterized especially by the style and the manner of living. The experiment of innocence is made vulnerability in direct relationship to the otherness and soustendue of intentionnality. The pathological conviction of innocence is important to include/understand, because it is marked in a context of derealisation darkening the conscience of the acts. And this conviction is in one lived of persecution. The charged act is not recognized and the subject brings it back to the other, in the more or less delirious conviction, always derealized, of its innocence. But, it is advisable to distinguish that well from the refusal. The culpability is an experiment able to invade the personalities. The sociological and psychological designs are with being differentiated well. But, it is important to distinguish well the various methods, culpability real, subjective, morbid, delirious culpability. The latter constitutes the center of pathologies melancholic persons able to take very serious forms many work show us that innocence and the culpability constitute contingent experiments     

The psychotic mummified hand: An unusual hand injury complication

The authors report the case of a patient with psychotic symptoms secondary to a posttraumatic stress disorder following a work-related hand injury. The somatic presentation was a “mummified” hand neglected for several years in a splint without any care. The psychiatric analysis concluded that this was part of a delusion of persecution expressing a conflict against the patient's employer and insurance company. Surgical treatment was limited to a hand cleaning with hardware removal. Despite 3 years of antipsychotic medication the patient was still suffering from delusion and the hand remained neglected at the last follow-up.     

Détection et intervention précoce : un nouveau paradigme

Treating psychotic disorders in their earliest stages has become a focus for research and clinical care worldwide. Specialized programs for early detection and early intervention in psychosis in adolescents and young adults have developed in many countries and have shown their effectiveness. After a first psychotic episode, the quality of functional remission is best when specialized care is proposed at the earliest. Moreover, the period preceding the emergence of a constituted disorder (“prodromal”) is a period of opportunity for preventive interventions that reduces the risk of transition to psychosis. These programs have further shown that the evolution of a mental state at-risk of psychotic transition, presenting some symptoms, towards a full-blown psychotic episode or from a psychotic episode to a chronic schizophrenic disorder are not inevitable. France has not yet developed these practices at the national level, but some initiatives are emerging and the French Transition network, within the Institute of Psychiatry, participates in the French-speaking branch of IEPA. The deployment of such programs is a real societal challenge and represents a paradigm shift: it questions the practices and the organization of the healthcare system, but also the way health care professionals and the general public look at these diseases.     

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.     

Mélancolie délirante et paranoïa : diagnostic différentiel

Objectives

In this paper, the author proposes to separate delirious melancholy and paranoia, locating in these two psychoses the common points and points which are able to distinguish them clearly.

Methodology

We present the delirious melancholy according to the psychiatrist H. Ey's theory, then – with psychoanalytical approach, according notably to Lacan – we will underline three important points of reference: relationships with “fault”, with the “object”, and finally with the “Other” (Lacan).

Results

These three points will lead us to the melancholic self-accusation and to the paranoiac accusation, to the position of “exception”, and to delirious common themes.

Discussion and conclusion

Finally, we attempt to ascertain – as Freud formulated about paranoiac delirium – whether melancholic delirium could also be a “tentative of (self) cure”.