Occultation oculaire et négligence spatiale unilatérale. Intérêt en rééducation

The use of eye-patches allows to modulate the visual information treating process. Twelve subjects with a left unilateral spatial neglect, randomly divided into three groups — non treated, treated by right eye complete patching, treated by right hemifield patching — were assessed at 1 month and 3 months after acute episode, by means of functional and neuropsychological tests. Results in the subjects treated by complete eye-patch [5]show an improvement of all the assessment parameters whatever the unilateral spatial neglect seriousness degree may be. The progression is less convincing in the patients treated by eye-patch in right hemifield. The effects of the different modalities of occultation interpreted on the basis of anatomo-physiological and psychophysiological patterns of attention, suggest the role of ocular occultation in the initial, voluntary and directed, coven attention recovery and secondary of the automatic and divided overt attention.     

Les adolescents violents. Réflexions cliniques,psychopathologiques et thérapeutiques

Purpose

Based on observations done in consultations by a psycho-analytic oriented child psychiatrist, in two Educative Reinforced Centers in France, the aim of this article is to understand some of the psychic and identity forming processes taking place within violent and delinquent adolescents.

Les antécédents d’adversité chez les agresseurs sexuels

This study compares the childhood adversity between sex offenders (n = 74) (paedophiles, n = 19; Incestuous, n = 28, rapists n = 27) non sexual offenders (n = 18) and non offenders (n = 15). The antecedents concerned: neglect, antipathy, physical, sexual and psychological abuses by the father or the mother. The adversities were evaluated by the « Childhood Experiences of Care and Abuse » questionnaire, CECA-Q. Physical abuse was more frequent among offenders groups than non offenders. The level of severity of physical abuse by the mother was higher among non sexual offenders as compared to incestuous and rapists. The same level by the father was higher among non sexual offenders as compared to rapists. Sexual abuses were more frequent among paedophiles than non sexual offenders and non offenders. Among sexual offenders, le level of severity of sexual offence was the highest among paedophiles. The level of severity of father antipathy was higher among paedophiles, incestuous and non sexual offenders as compared to non offenders. There was no difference concerning the levels of neglect and psychological abuse between the groups. The overall results are congruent with the literature mentioning that sex offenders experience diversified and correlated adversities.     

Unilateral spatial neglect: a dramatic but often neglected consequence of right hemisphere damage

INTRODUCTION: Unilateral Spatial Neglect (USN) is a common consequence of right brain damage. In the most severe cases, behavioral signs of USN can last several years and compromise patients' autonomy and social rehabilitation. These clinical facts stress the need for reliable procedures of diagnosis and rehabilitation. STATE OF THE ART: The last 3 decades have witnessed an explosion of studies on USN, which raises issues related to complex cognitive activities such as mental representation, spatial attention and consciousness. USN is probably a heterogeneous syndrome, but some of its underlying mechanisms might be understood as an association of disorders of spatial attention. A bias of automatic orienting towards right-sided objects seems typical of left USN. Afterwards, patients find it difficult to disengage their attention in order to explore the rest of the visual scene. Neglected objects are sometimes processed in an "implicit" way. PERSPECTIVES: The development of behavioural paradigms and of neuroimaging techniques and their application to the study of USN has advanced our understanding of the functional mechanisms of attention and spatial awareness, as well as of their neural bases. A number of new procedures for rehabilitation have recently been proposed. CONCLUSION: The present review describes the clinical presentation of USN, its anatomical basis and some of possible accounts of different aspects of neglect behavior. Results of computer simulations and of rehabilitation techniques are also presented with implications for the functioning of normal neurocognitive systems.     

Does galvanic vestibular stimulation reduce spatial neglect? A negative study

IntroductionIn spatial neglect, the functional benefit of rehabilitation methods is subject to debate. A few studies have reported that galvanic vestibular stimulation (GVS) is efficacious in spatial neglect. The objective of the present study was to establish whether the effects of GVS persist after the end of stimulation.MaterialsFour patients with pathological rightward deviation in a bisection task at least three months after right hemisphere stroke. A single-blind, randomized crossover design was used to assess the effects of GVS on performance in line bisection and star cancellation tasks under three different conditions (cathode-right, cathode-left and sham stimulation).ResultsThere were no significant differences in the performance of either task following GVS (relative to sham stimulation).ConclusionGalvanic vestibular stimulation did not reduce spatial neglect symptoms in any of the stimulation conditions. Further studies are necessary to understand the disparity between our results and those reported in the literature. Repeated sessions, a higher current intensity and/or alternating-current stimulation may improve this method before it can be used clinically.     

Claustration et collectionnisme : réflexions à propos d’un cas de syndrome de Diogène avec vols kleptomaniaques et vengeurs

Social withdrawal is a pathognomonic behaviour that is consistently associated with mental illnesses. Compulsive hoarding can also be interpreted as a pathological behaviour, even when it does not involve kleptomania. Diogenes syndrome (DS) was first described in 1975, and is characterized by both behaviours - social withdrawal and compulsive hoarding. Even though it is often the manifestation of a psychiatric condition, its aetiology is diverse. The most frequent ones are however: dementia, schizophrenia and mental retardation. In this study, we describe an atypical case presenting with DS. Il consists of a young man, seen in a forensic setting, who had been diagnosed with kleptomania in the past, presents with compulsive hoarding, and whose recent thefts were fuelled by revenge. Finally, to our knowledge, the way social withdrawal is viewed is seldom taken into account. We analyse its implication on social withdrawal.     

Le vidéo feedback dans des situations de négligence émotionnelle : un outil d’évaluation et de soins des interactions précoces ?

In the early childhood clinic, video feedback device consists usually in showing to the parent a video of him/her playing with his/her child, accompanied with an interview. In situations of severe emotional neglect, a common but discrete form of abuse, the use of video feedback seems relevant in the care of the early interaction. In the setting of a larger study, a video feedback device: the Insightfulness Assessment (Koren-Karie and Oppenheim, 2001) has been proposed to mothers in situation of severe emotional neglect. It allows to explore but also to support insightfulness, valuable skills for the quality of the early interactions. The video feedback device also has a therapeutic scope in some situations by supporting parenting skills and giving narcissistic support. It might be a projection support and a therapeutic mediation tool.