Limites et dangers des DSM

The publication of the DSM-III rating scale in 1980 marked a definite turning point in the development of modern psychiatry. For those responsible for elaborating it, it appeared to have resulted in psychiatry being accepted as a science. However, this was at the expense of eliminating the subjective aspect, both that of the patient and that of the clinical practitioner. As a result of this, it was possible to utilize a common language which permitted high inter-scoring diagnostic accuracy. The success of the DMS-III and IV is based on their affinity with scientific ideals, and with their association with clinical medication. In focusing on target symptoms devoid of all dynamism, they implicitly relate them to bodily dysfunctions. Twenty years after the introduction of this approach presented as being atheoretical, its main justification, i.e. diagnostic accuracy, has been shown to be ill-founded, while the problems of diagnostic validity are eluded. The DSM scales have relegated mental disorders to being infinitized, and the pursuit of this approach could eventually lead to treatment by computerized psychiatry. These rating scales also lead to an impoverishment of clinical consultations; they do not take into account the possible reticence of the patient; and they generate implicit normative ideals. Even amongst their proponents, certain individuals are beginning to see that they could constitute a serious disadvantage to the progress of psychiatry.     

Starch digestibility modulation significantly improves glycemic variability in type 2 diabetic subjects: A pilot study

Background and aimsIn type 2 diabetes (T2D) patients, the reduction of glycemic variability and postprandial glucose excursions is essential to limit diabetes complications, beyond HbA1c level. This study aimed at determining whether increasing the content of Slowly Digestible Starch (SDS) in T2D patients’ diet could reduce postprandial hyperglycemia and glycemic variability compared with a conventional low-SDS diet.Methods and resultsFor this randomized cross-over pilot study, 8 subjects with T2D consumed a controlled diet for one week, containing starchy products high or low in SDS. Glycemic variability parameters were evaluated using a Continuous Glucose Monitoring System.Glycemic variability was significantly lower during High-SDS diet compared to Low-SDS diet for MAGE (Mean Amplitude of Glycemic Excursions, p < 0.01), SD (Standard Deviation, p < 0.05), and CV (Coefficient of Variation, p < 0.01). The TIR (Time In Range) [140–180 mg/dL[ was significantly higher during High-SDS diet (p < 0.0001) whereas TIRs ≥180 mg/dL were significantly lower during High-SDS diet. Post-meals tAUC (total Area Under the Curve) were significantly lower during High-SDS diet.ConclusionOne week of High-SDS Diet in T2D patients significantly improves glycemic variability and reduces postprandial glycemic excursions. Modulation of starch digestibility in the diet could be used as a simple nutritional tool in T2D patients to improve daily glycemic control.Registration numberin clinicaltrials.gov: NCT 03289494.     

L’utilisation de placebos dans le traitement de la douleur: résultats d’une enquête préliminaire en milieu hospitalier

Résumé  Le groupe de travail ?Ethique et douleur? de la Société pour l’étude et le traitement de la douleur (SETD) a effectué une enquête préliminaire relative à l’usage de placebos en milieu hospitalier. L’enquête a été faite par questionnaires dans 19 unités de soins, les réponses de 219 infirmières et 100 médecins ont pu être exploitées. Parmi les médecins 35% utilisent ?parfois? ou ?rarement? des placebos dans le traitement de la douleur, de même que 53% des infirmières. Les placebos sont plus volontiers utilisés dans les douleurs psychogènes, dans les échecs de traitements antalgiques, dans les douleurs chroniques ou devant des plaintes réitérées de malades jugés difficiles. Les commentaires des profesionnnels de santé interrogés montrent que les représentations dominantes de la douleur et des thérapeutiques ne prennent pas en compte les différentes composantes de la plainte douloureuse ni les connaissances actuelles relatives aux mécanismes de l’effet placebo.      

Medication and pregnancy counseling, an incomfortable role for the retail pharmacists

Tragedies subsequent to use of medication at the beginning of pregnancy have given rise to extreme distrust, placing the retail pharmacist in an uncomfortable situation. A survey of pharmacists in France has revealed that pregnant women ask for more information than any other patients, particularly when it comes to continuing medication started before pregnancy. In such cases, 57% of the polled pharmacists recommended discontinuation of the medication. Ninety percent thought they were sufficiently informed and massively recommended a prudent attitude. Their wish was to have an independent high-performance information tool available. There is such a tool: the Teratogenic Agent Information Center, rarely used by pharmacists. With the support of such a structure, 80% would be eager to take on more responsibilities in counseling patients and preventing teratogenic risks, in relation with other healthcare workers, thus guaranteeing high-quality medication counseling.