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Résumé Les méthodes d’évaluation du risque et des besoins des personnes contrevenantes ont grandement évolué au cours des 40 dernières années. Elles sont passées d’une évaluation impressionniste basée sur l’expérience clinique à une procédure systématique basée sur la recherche scientifique. Ce n’est toutefois que très récemment que les professionnels ont été en mesure d’avoir accès à un instrument spécifiquement conçu pour évaluer les facteurs de protection contre la récidive et la récidive violente. La Structured Assessment of Protective Factors for Violence Risk (SAPROF) est un outil utilisant le jugement professionnel structuré afin de documenter les éléments protecteurs chez les auteurs d’infractions. Elle comporte 17 domaines protecteurs répartis en trois grandes catégories de facteurs : les facteurs internes, les facteurs liés à la motivation et les facteurs externes. La SAPROF jouit d’un engouement important tant dans les milieux cliniques que chez les chercheurs et constitue un ajout utile au processus clinique d’évaluations des personnes. Risk assessment has greatly changed over the last 40 years. It has moved from a strictly clinical procedure based on clinical judgement, to a structured approach based on scientific literature. While the main goal of first generation structured methods was to estimate the probability of recidivism, we are increasingly interested in knowing more about the reasons that push delinquents to commit new crimes in order to properly intervene and treat the causes at hand. The last generations of instruments now aim to estimate intervention needs and guide rehabilitation practices. Although practitioners largely resort to protective factors to establish avenues to work on, no tool was available until recently to systematically evaluate protective factors. The present article proposes a description of the different measurement and conceptualization issues surrounding protective factors, in addition to addressing the nature of the effect of these factors on recidivism. This paper describes The Structured Assessment of Protective Factors for Violence Risk (SAPROF), a structural professional judgement tool that focus solely on protective factors for violence risk. The SAPROF investigates internal, motivation and external protective factors and has incremental validity over risk assessment instruments. The paper also discusses validation results of the SAPROF, as well as its limitations. The paper finally addresses the crucial question of interfacing risk and protective factors when it comes to estimating the risk for recidivism. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Nous tenterons de situer, dans le contexte psychiatrique et psychanalytique de son temps, l’article sur la genèse de « l’appareil à influencer » de Viktor Tausk. Méthode Nous verrons comment, comme sorte de synthèse de travaux sur l’évolution des délires, ont émergé des travaux structuralistes en psychiatrie qui ont permis une meilleure analyse des phénomènes automatiques dans les psychoses, qui ont été aussi au carrefour de la rencontre entre les travaux psychiatriques de Clérambault et le mouvement structuraliste en psychanalyse. Résultats À ce même carrefour, se situe le travail de Tausk sur l’automatisme dans les psychoses. Discussion Il est, de ce fait, structuraliste avant son ère, car il va au-delà de la théorie freudienne sur les psychoses de cette même période, jusqu’à une conception du « symptôme » psychotique en tant que « condensateur de jouissance ». Conclusions Ce n’est pas un hasard si à l’époque de l’automatisation de la production ont émergé des théories psychanalytiques sur l’automatisme créateur de l’inconscient, et, de plus, sur les phénomènes automatiques dans la psychose. Objectives This paper will attempt to place Viktor Tausk's famous article on the genesis of the “influencing machine” in schizophrenia within the psychiatric and psychoanalytic context of its time, particularly in relation to the concepts of structure and automatism. Methodology/approach Following the summary of Tausk's paper, we will analyse the predominant ideas concerning the evolution of delusion in time, in psychiatry of the end of the 19th century and the beginning of the 20th. We will then look into how, as a result of this evolution, some more or less structuralist works arose, which permitted, among other things, a better analysis of automatic phenomena in psychoses. These phenomena have also been at the confluence of the psychiatric work of Clérambault and the psychoanalytic structuralist movement initiated by Jacques Lacan. Results It is at the crossroad between the works of the two that we may place, though in an independent register, Tausk's pioneering work on automatism in psychoses, which is not only a commentary on the evolution of delusion, but also on the underlying element that presides over delusion, from the point of its initial hypochondriac state to the generation of persecutory delusion ideas, amongst which the existence of an “influencing machine”. Discussion Tausk's work, akin to Clérambault's and Lacan's on automatism, may thus be considered structuralist before its time. More specifically, his swan song – the “influencing machine” paper – goes beyond the Freudian theory on psychoses of the time, which focused on the psychotic's denied homosexuality, and up to the concept of the psychotic “symptom” as a capacitor of enjoyment ( jouissance ). Conclusions It is most singular that at the time of production's automation during the industrial revolution, not only were delusions modified in relation to this evolution, but there was also the development of psychoanalytic theories on the creative automatism of the unconscious, and on the automatic phenomena of the psychosis, which are related to the former. Concerning these phenomena, the influencing ideas have been the subject of several studies, by Freud and Tausk firstly, and by Clérambault and Lacan later on, each time both accusing the other of plagiarism. [ABSTRACT FROM AUTHOR]

Résumé Thérèse Lempérière a accompagné l’émergence de la psychopharmacologie. Ses travaux concernent autant l’efficacité des psychotropes (antidépresseurs, neuroleptiques) sur les différents symptômes que l’induction de symptômes par certaines substances psychotropes (amphétamine, psilocybine). Ou encore l’étude des effets neurologiques des neuroleptiques et l’analyse de l’apport des traitements retards. Son regard sur la pharmacologie est celui d’une clinicienne et reste en cela très actuel : l’analyse fine clinique des effets des psychotropes sur le psychisme et le système nerveux central, qui a initialement permis d’affiner les indications des molécules, continue à être aujourd’hui la principale source permettant d’améliorer la connaissance en psychiatrie et sciences de la cognition, mais aussi et surtout de rechercher de nouvelles pistes thérapeutiques, au-delà des catégories diagnostiques et en dehors de leur indication première, ou de rechercher la meilleure adéquation du profil thérapeutique à un profil clinique. Objectives This paper is a tribute to Thérèse Lempérière's legacy regarding the study of psychotropic substances and an analysis of the lessons from her work for the future of psychopharmacology. Materials and methods All her historical papers, mainly published in French journals, were reviewed as well as the summary of “titles and works” written by her. Rather than a comprehensive review, we have selected some papers in order to cover the various domains she addressed and to highlight some main characteristics of her work and envision. The paper also analyze her work in the context of the remarkable progresses of psychopharmacology in the second part of the 20th century as well as new perspectives for future innovations. Results Thérèse Lempérière started studying psychotropic drugs in 1953, in the department where the antipsychotic effects of chlorpromazine were discovered. In the same line as these pioneering observations, her work widely covers the study of various compounds, with a specific interest for clinical descriptions of therapeutic effects in patients of new drugs as well as induction of symptoms by substance of abuse in patients or healthy volunteers. She explored every classes of the classification proposed by J. Delay in 1957 (adopted by the 1961 World Congress of Psychiatry) i.e. psycholeptics including neuroleptics and mood stabilizers, psychoanaleptics such as nooanaleptics (amphetamine) and thymoanaleptics (antidepressants) and psychodysleptics especially psilocybine. Regarding amphetamine, T. Lempérière discussed the differential diagnosis between pharmacopsychose and what she called ‘amphetaminic pseudopsychosis’ when psychosis persist after withdrawal and proposed that amphetamine reveals previously quiescent predisposition to schizophrenia. She underlined the bidirectional relation: amphetamine induces psychosis but also amphetamine as a self-medication for early dysfunction of schizophrenia. A picture very similar to current view on cannabis precipitated psychosis or self-medication by cocaine. T. Lempérière studied several classes of antidepressant from the early tricyclic to very recent ones. In the ‘two-year of experience with imipramine’ article, she reviewed the best indications and factors of good response (melancholia, simple depression, women) while imipramine has low efficacy in severe melancholia and hypochondria. She proposed the association of imipramine to reduce the number of ECT and indicate some efficacy in OCD. The descriptions of psilocybine in healthy volunteers and patients are full of information regarding the individual variability and the semiology of psychotic-like experiences induced by psilocybine (illusions, “hallucinose”, pseudohallucinations rather than hallucinations). Of course, Thérèse Lempérière's explored the neuroleptics, many of them, with a special focus to analyze the differential therapeutic profile of each molecule, in order to improve the adequacy to the patient's profile. A main contribution was the study of reserpine, starting in 1954, that, together with the observation with chlorpromazine, contributed to the definition the of neuroleptics’ class. These included the presence of extra pyramidal signs, which Thérèse Lempérière also explored, including tardive dyskinesia. She rapidly recommended to prescribe neuroleptic at the minimal efficient dose and to avoid systematic prescription of anticholinergic drug. Thérèse Lempérière promoted the use of long acting neuroleptics early in the disease, since they prevent treatment interruption and facilitate the alliance. Regarding the mood stabilizers, Thérèse Lempérière contributed to the introduction of valpromide and valproate in psychiatry. Conclusions Thérèse Lempérière is a pioneer woman in French Psychiatry, and her legacy is not restricted to the field of psychopharmacology. Her remarkable contribution is mainly due to her clinical vision and analysis. The overview of the Thérèse Lempérière's contribution to psychopharmacology underline several features of the early history of psychopharmacology: the origin of psychotropic drugs out of neurosciences (antibacterial, antiparasitic, antihypertensive, etc.), the close relation between clinician and chemists from pharmaceutical company, rapid transfer to the clinic and rapid feedback to the pharmaceutical companies, the fine clinical (phenotypic) descriptions, the use of psychotropic drugs to dissect psychiatric syndromes. These are invaluable lessons to apply for the future developments of psychopharmacology. They plead for a reinforcement of translational psychiatry with always more bidirectional relations between clinics and basic sciences and advocate for reopening the borders between psychiatry and other medical disciplines. [ABSTRACT FROM AUTHOR]

Résumé Les noms communs de « psychose » et de « névrose » ont été transmis par des générations de praticiens pour rester d’un usage habituel dans les services de psychiatrie clinique. Mais comment ces mots dont le signifié moderne débute avec Freud auraient-ils pu rester concordants jusqu’à notre clinique contemporaine ? Quels sont les arguments pour ou contre la pérennité de ces appellations ? Après un bref historique resituant les origines de ces termes de « névrose » et de « psychose », nous détaillons l’analyse syntaxique et lexicale de leurs définitions rapportées par quatre ouvrages célèbres de notre psychiatrie francophone (H. Ey, T. Lempérière et J. Guelfi, P. Juillet). La réflexion du psychiatre par rapport à l’interrogation définitoire des « névroses » et des « psychoses » est concordante à la critique phénoménologique du diagnostic psychiatrique : ce que l’on appelle « névrose » et « psychose » traduit une intuition clinique globale dont la caractérisation définitionnelle signifiée est difficile. Dans notre clinique contemporaine, les termes de « névrose » et de « psychose » sont employés par des praticiens d’horizons et de pratiques divers qui partagent, ou non, les mêmes a priori conceptuels : ce que le clinicien appelle couramment « névrose » comme « psychose » est plutôt de l’ordre de la typologie diagnostique que du modèle ou du concept. Background We seek to establish whether there is a consensus definition of the terms “neurosis” and “psychosis” among contemporary writers of French language. How words whose modern meaning begins with Freud might have remained consistent to our contemporary clinic? Method A research methodology like critical review of the literature was not possible because of a too small number of papers referenced with the keywords of “neurosis” or “psychosis”, papers which offered still more rarely explicit definition or implied terms neurosis and psychosis. We therefore opted for a methodology of analysis of lexical and syntactic definitions fields recorded within four famous works: The Manuals by Henri Ey, Thérèse Lempérière and Julien Guelfi, and the Dictionary of Psychiatry by Pierre Juillet. Results Theoretical benchmarks used are not directly explained even if the lexical analysis discovers a multitude of implicit conceptual bases. Parsing found that the terms “neurosis” and “psychosis” on the one hand, and different conceptual or more generically the various notions bases referred to by the authors on the other hand, are not connected by logical links explicit characterizing relations involvement, cause or consequence, but remain joined or juxtaposed. In addition, the nature of the relationship between the definition of “neurosis” and the “psychosis” is not obvious: the separators served most consistent result from the subjectivity of the interview. Discussions The reflection of the psychiatrist in relation to the definitional question of “neuroses” and “psychoses” is consistent with the phenomenological critique of psychiatric diagnosis: what is called “neurosis” and “psychosis” reflects a clinical intuition whose definitional characterization is difficult. The reference to the symptom, syndrome or disease, so diagnosis may be here surpassed by “category”, “type” or “structure”. Conclusions While definitions of what is called “neurosis” and “psychosis” in the future could change depending on the societal context in which they are expressed, it should be noted that since Freud clinical impression of what the essence of “neurosis” or “psychosis” is passed from one generation to another practitioner rather independently of these definitional possibilities. In our contemporary clinical terms “neurosis” and “psychosis” are used by practitioners of various backgrounds and practices that share or not the same conceptual a priori: what the clinician commonly called “neurosis” as “psychosis” is more an intuitive prototype than a model or a concept. [ABSTRACT FROM AUTHOR]

Résumé Cet article part d’une réflexion concernant des écarts importants obtenus chez deux auteurs pionniers dans la question du profilage géographique (D. Canter et K. Rossmo), le premier étant Anglais et le second Canadien. Si leur postulat de base était identique, leurs résultats divergeaient. Nous nous sommes alors intéressés à la question de l’environnement immédiat, les écarts topographiques et l’urbanisme dans ces continents pouvant être une des variables expliquant certaines des différences constatées dans ces comportements et la forme qu’ils revêtaient entre les deux côtés de l’Atlantique. Si le rôle joué par l’environnement primaire, les premières interactions avec les parents, n’est pas négligeable dans le développement psychoaffectif et la constitution de la personnalité d’un individu, nous nous focaliserons à travers ces pages sur la place tenue par l’environnement urbain, au sens premier du terme « environnement », dans les actes d’agressions sexuelles sérielles. La question en filigrane étant de considérer en quoi la perception de l’espace des auteurs d’agressions sexuelles sérielles (AASS), leurs « cartes mentales », dépendrait essentiellement de la culture dans laquelle ils se développent et comment cela pourrait avoir des incidences sur leurs zones « d’action » ? La forme de ce travail est celle d’une revue de la littérature, en partie du fait de la difficulté d’accès à cette population pour des travaux criminologiques. Les illustrations cliniques proviennent soit de ressources personnelles, après modifications des noms, soit livresques. Ce travail ne proposera pas de valeur statistique mais plutôt une hypothèse de réflexion. Objectives This article deals about an aspect not taken into consideration often when considering violent sexual offenses. The term “crime scene”, which got widespread into common language, depicts all the elements collected at the place where a crime occurred and which could later become pieces of evidence. However, the place by itself, the link between the offender and the place, the influence of the urban environment and the cultural aspect of it do not receive that much attention in the literature. This paper originates from a comparison of the work of two psychologists specialized within the field of geoprofiling, D. Canter and K. Rossmo, the latter being a Canadian citizen and the former an Englishman. If their postulates were similar, their findings however diverged. If primary caretakers and early interactions are not to be underestimated regarding their roles into the personality development, we will in these pages consider the urban environment by itself in serial sexual offenses. Methods Due to a restricted access to this type of patients, we mainly focused our hypothesis on a literature review and a few patients of ours, met during previous research works. Concepts used in this paper overlap various fields such as psychodynamic, criminology, criminalistics, psycho-sociology and even urbanism. We focused in this paper onto the importance of the culture and the urban concrete environment as probable variables explaining these discrepancies observed into the behavioral patterns and distances covered by Serial Sex Offenders between the two shores of the Atlantic. The underlying question being how their space conception, their “mental maps”, depends of the culture they were bred in and how it could have an incident onto their offense zones? Results The findings highlight an inherently cultural variation of the spatial conception, but also how the space is built up and integrated between the USA (and all the large and historically “recents” territories) and Europe. American sexual serial offenders are more likely to cover larger distances, almost twice as much than their European counterparts. It seems that our hypothesis is relevant; a cultural distinction may exist on the way spatial environment is perceived and could thus have incidences into the offense patterns. Conclusions With the development of the E.U., our spatial conceptions as European citizens evolve. Thanks to mass transportation, and the Erasmus programs, it is not uncommon for an Italian individual to study in Scotland or Finland for instance. This is of some importance into how the spatial mobility is becoming more thinkable, and somehow how it induces a shrinkage of the distance into the mental mapping process. [ABSTRACT FROM AUTHOR]

Résumé La traduction française du DSM-5 sera publiée (Elsevier) en juin 2015. Cette communication résume l’historique des traductions françaises des DSM depuis le DSM-III en 1980. Nous sommes restés fidèles aux principes antérieurement retenus, à savoir traduire plutôt qu’adapter et respecter – sauf exceptions – le style de la version originale, avec ses répétitions systématiques. De nombreux exemples sont donnés des choix que nous avons effectués. La seconde partie concerne l’utilisation des quelque 65 outils psychométriques recommandés par les auteurs, en libre accès gratuit sur Internet, pour la plupart non traduits et non validés, pour lesquels les règles méthodologiques d’adaptation et de validation ne pourront pas être respectées. The French translation of DSM-5 will be published by Elsevier Masson in June 2015. This paper summarizes the historical background of the French translations of DSM since 1980 (DSM-III). The translation team has remained true to the principles of previous translations, namely choosing scientific accuracy rather than literary adaptation, and respecting the unique style of the Handbook, with its systematic repetition of phrases and expressions referring to diagnoses. There were very few real problems of translation. Some terms, however, have been the subject of various translation proposals. Other terms have been translated differently depending on context, reflecting the fact that most English and French words are polysemic rather than univocal. Many examples are given of the choices we have made. The second part of the paper is about the emerging measures recommended in DSM-5 section III. These tools (more than 65 questionnaires, inventories or rating scales) can be accessed freely online. Their use is recommended to “enhance the clinical decision-making process, with level 1 cross-cutting self/informant related measures that serves as a review of systems across mental disorders, and level two disorder-specific severity measures”. Most of these assessment measures are not validated in French. The methodology for validating translated inventories or rating scales has been well known since the early sixties. And International guidelines have been recently published in this field. These validation studies are long, difficult and costly. They implicate a tremendous amount of work that will not be achieved for the tools recommended in the DSM-5. The Manual makes no reference to these problems. The validity in uncontrolled conditions of psychometric tools posted on the Internet has to be studied. The equivalence of administering an online version of rating scales or personality tests was assessed in several papers with contradictory results. These results need to be confirmed in the general population and in representative clinical samples. [ABSTRACT FROM AUTHOR]

Résumé Après l’urgence chirurgicale du traumatisme physique vient le temps de la reconstruction faciale, physique, mais aussi psychique, moins visible et parfois bien plus complexe. L’auteur se base sur le travail clinique d’un atelier thérapeutique autour du portrait, plus précisément en se référant à deux séquences cliniques de ce groupe pour examiner les liens étroits entre la création et la restauration de l’image de soi. Cette étude monocentrique a été menée dans une unité de chirurgie réparatrice à Amman (Jordanie), avec près de 200 victimes civiles de la guerre civile en Irak sur une durée de six mois. Ce travail sur le terrain permet de mettre à jour la diversité des mécanismes et des étapes par lesquelles passent les mutilés de guerre afin de se reconstruire une identité. À travers l’atelier portrait apparaît la symbolisation de la phase dépressive qui précède la reconstruction identitaire. Reconstruction comes after the surgical intervention for a physical trauma. The rebuilding of the face involves psychological as well as physical processes. The psychological aspect of reconstruction is less visible but more complex. The findings of therapeutic workshops based on the concept of “the face” have been invaluable. Clinically, the workshops referred specifically to an examination of the links between the creation of and restoration of self-image. This six-month long, mono-centric study took place in a surgical ward in Amman (Jordan) which treated almost 200 civilian casualties of the Iraqi civil war. The results improve our knowledge of the diversity of the mechanisms and stages that the casualties experienced to rebuild their identity. The first stage was to ask the patients to draw a self-portrait. All the patients portrayed themselves before their trauma. Then they were then asked to draw themselves as they were “now”, ie: after the trauma. Dira, a young burns patient, looked at himself in a mirror for the first time since the accident. For his second self-portrait he chose a variety of different papers and materials to portray the scars and the different textures of his skin. Another child used stickers to portray himself like a mosaic. Most of the patients started their work with a pencil paper and drew an oval. This portrayed the “real face”, the one hidden under the scars, the burnt skin, the bandages… Hidden, like in Dira's self-portrait, under the different layers of paper. By hiding his original face, which was still there but unattainable, he portrayed his loss and fragility. It can be seen from this workshop that the whole body image is modified after physical trauma. The intensity of the care, the pain, and the bandages is an emotional investment. They become a type of protection but also an obstacle to the process of restoring the body image. The perception of one's body as “damaged” causes a serious imbalance of the patient's self-image because of the emotional association with a deep feeling of fragility. In turn, this sense of physical fragility is closely connected to its mental equivalent. The patient's spirit goes through a destructive phase because of the external and internal emotional overload. This mechanism, which drives the body image, can slow down mental development when the patient is a child or a teenager. This destructive stage of recovery precedes the reconstruction of the patient's identity. The therapeutic workshop illustrates the symbolic importance of this stage by exposing the link between the wish to gather together the fragmented body image post-trauma and the cutting-out that Dira did for his post-trauma self-portrait. The patient rebuilds his self-image by gathering it together piece by piece. Therapeutic workshops and individual therapy enables patients to verbalize their anxieties. Therapy helps them to overcome their fear of the physical reality of their trauma and to reconstruct their psychological identity simultaneous to the surgical reconstruction. [ABSTRACT FROM AUTHOR]

Résumé Nous assistons actuellement à une inflation du nombre de journaux scientifiques et du nombre d’articles publiés dans des revues indexées. En pratique, 60 % des articles sont cités moins de 2 fois et donc probablement jamais lus. Sachant que les financements des auteurs scientifiques dépendent de leurs publications, tout les encourage à publier, et ce quelle que soit la portée de leurs résultats. On observe par conséquent l’émergence de techniques visant à amplifier artificiellement le nombre et l’impact des articles publiés. Cet article détaille quelques-unes de ces techniques : le perroquettage , le saucissonnage , le marketing, les co-auteurs « stars » fantômes, la mise en ligne précoce des articles acceptés, l’organisation en cartels, la multiplication des revues de littérature, et la disparition progressive des cas cliniques. Dans le paysage de la recherche biomédicale, la psychiatrie se situe extrêmement bien par rapport aux autres disciplines médicales. En effet, plusieurs revues en psychiatrie et en neurosciences possèdent des facteurs d’impact parmi les plus élevés des revues médicales. Malheureusement, la psychiatrie n’échappe évidemment pas aux dérives décrites précédemment. Des pistes sont proposées dans cet article pour pouvoir sortir de cette impasse et bénéficier d’une évaluation rénovée de la qualité scientifique. Enfin, la question des sciences humaines est également discutée en lien avec les processus de publication actuels. We’re currently witnessing an inflation of the number of scientific journals and of papers published in indexed journals. Indeed, 60 % of papers are cited less than twice and so probably are never read. Because the financing of scientific authors is based on their publications, everything encourages them to publish always more, and this regardless of the significance of their results. So emerging techniques to artificially boost the number and the impact of papers appear. We detailed here some of these key techniques: self plagiarism, salami slicing, marketing, famous ghost co-author, early online preview of accepted articles, cartels organization, proliferation of literature reviews, and gradual disappearance of clinical reports. Mapping the landscape of the biomedical research, psychiatry is extremely well-positioned compared to other medical disciplines. Indeed, many journals in psychiatry and neurosciences have impact factors among the highest of medical journals. Unfortunately, psychiatry is not immune to the drifts developed above. Ideas are proposed in this article to get out of this impasse and benefit from a renewed scientific quality assessment. Finally, the question of the humanities is also discussed in relation to the existing publication process. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Dans cet article, les auteurs présentent et illustrent l’intérêt d’une approche systémique des soins psychiatriques sans consentement dans leur phase initiale, hospitalière. Méthode À partir d’une revue ciblée de la littérature psychiatrique et systémique, les auteurs définissent les concepts systémiques qui peuvent s’appliquer à la prise en charge psychiatrique des situations de crise conduisant aux soins sans consentement. Ils rendent également compte d’une pratique quotidienne dans un service intersectoriel fermé. Trois vignettes cliniques sont présentées afin d’illustrer le propos. Résultats En repérant le rôle interactif de chaque protagoniste, en soulignant la fonction du symptôme et de l’intervention psychiatrique, le courant des thérapies familiales et systémiques propose une grille de lecture des soins sans consentement et un modèle d’intervention créatif avec le patient et son entourage. L’abord systémique du cadre légal permet en outre la mise en valeur et l’utilisation du principe de triangulation avec l’instance judiciaire. Les cas cliniques révèlent la pertinence mais aussi les limites d’une intervention systémique précoce, en cours d’hospitalisation. Le dispositif de l’intervention doit être suffisamment souple pour s’adapter à chaque situation de crise. Le contexte d’intervention peut être restreint et le caractère opératoire de l’entretien systémique, comme pour toute approche psychothérapeutique, dépend également de la qualité de la rencontre entre les soignants, le patient et les personnes de son entourage qui ont pu être mobilisées. Conclusion Les propositions théoriques et l’illustration clinique de cet article font ressortir la plus-value potentielle et les limites de l’approche systémique en cours d’hospitalisation sans consentement. Objectives Family involvement in mental health care has been shown to reduce relapse and facilitate recovery of psychiatric patients. This paper describes systemic concepts and practices relevant in the specific context of compulsory admission. Materials and methods Based on a focused review of systemic concepts, this work presents the critical elements of a systemic intervention during psychiatric hospitalization without consent and discusses them within three clinical case studies. Results In undertaking the care of any psychiatric patient, systemic factors need to be considered. Psychiatric symptoms and reasons for compulsory admission can be influenced by the relational context of the patient. Conversely, the functioning of a relational unit is affected by a member's psychiatric illness and hospitalization. By focusing as a matter of priority on human interactions and relationship, systemic theories offer a framework and therapeutic approach which prove useful to psychiatric work. The framework allows the psychiatrist to invite the family members and enlist them in the care of the patient by organizing a family meeting during the hospitalization without consent. Occurring as early as possible and only with the patient's agreement, the family meeting has several important aspects and objectives. First, the clinician can focus on interactions among the individuals involved and understand how these interactions are related to the psychiatric symptoms and the reasons for compulsory admission. In light of this, he can assess psychosocial resources, cultural background, and dispositions of the relatives, by evaluating how they function together in terms of cohesion, adaptability and problem solving skills. Element such as the expression and regulation of emotional tension in the family may be a focus of clinical attention. The family meeting also gives the opportunity to provide psychoeducation, by addressing the needs of family members for information, clinical guidance and support. Psychoeducation includes the provision of information in a way that is personalized, i.e. tailored to help to understand their own specific needs, according to the patient's stage of illness and context. In addition to providing relevant information, it is often useful to support and enhance the caregiving capacity of family members, reducing in this way the stress associated with their caregiving roles. Relatives may be recognized as important agents affecting the patients’ mental functioning and the path to recovery. Another goal in working with the family is to provide information concerning hospitalization without consent and its legal context. Many patients experience compulsory admission as coercive. The psychiatrist may enlighten the decision-making processes and consider ways of reducing this sense of coercion. The systemic approach proposes a way of reducing patients’ perception of coercion by emphasizing the key role of the legal system's representative. Finally, the article highlights the limitations of a family intervention occurring during the hospitalization. Family members and patients may have apprehension and be hesitant to engage in family intervention. « Family » must also be considered in the widest sense – parents, partners, siblings, and all significant others. Different interventions are likely to be more relevant during a first episode than for families who have been managing mental illness for many years. The family meeting settings must therefore be flexible about the content, structure and participants so that they can address different types of families and situations. Conclusions The article shows the contributions of systemic approaches to improving patient care in involuntary psychiatric hospitalization. [ABSTRACT FROM AUTHOR]

Résumé Les troubles de personnalité limite sont caractérisés par un certain nombre de manifestations éparses telles que des actes autodestructeurs, une angoisse massive, des affects intenses et labiles, des ruptures interpersonnelles et une grande impulsivité. L’objectif de cet article consiste ainsi à reprendre un certain nombre de données de littérature susceptible de dresser une vue d’ensemble des troubles de personnalité limite à la lumière de la théorie de l’attachement, en supposant que celle-ci puisse en expliciter les mécanismes à l’œuvre et rassembler les comportements décrits en une unité cohérente. Ainsi, l’étude étiologique basée sur l’attachement, englobant les modèles biopsychosociaux et plus particulièrement la question des traumatismes, permet d’éclairer la symptomatologie à la fois multiple et spécifique de ces troubles par le biais de mécanismes tels que l’activation du système d’attachement, la dysrégulation émotionnelle et la mise à défaut de la mentalisation. Borderline personality disorders concern clinicians and caregivers because of the violent and impulsive nature of their behavioral and affective reactions, which often confronts them to a feeling of helplessness and incomprehension. Indeed, it may be difficult to deal with self-harm, massive anxiety, intense affects and interpersonal ruptures, which are often present in the life course of the borderline patients. Their distress is particularly difficult to accept as it takes place in the therapeutic link, which reveals the core of the patient's attachment problematic. This paper aims to draw up an overview of borderline personality disorders, in light of attachment theory, which could help to clarify the involved mechanisms and gather the described behaviors in a coherent unit. Many studies relating to borderline personality disorder and attachment theory highlight what constitutes the specificity of these disorders through an integrative approach. Thus, the combination of an insecure attachment style, biological vulnerabilities and environmental stressors like traumatisms may induce the establishment of many defensive mechanisms, such as attachment system hyperactivation, emotional dysregulation or mentalization's failure. People suffering of borderline personality disorder activate these mechanisms as soon as they have to deal with real or imagined abandonments related to one of their attachment figures. However, in view of the massive anxiety and the severe disruption, those inefficient mechanisms cannot enable a good resolution of stressful situations. Consequently, borderline patients are likely to resort to new kind of emotional regulation such as suicidal, destructive and impulsive behaviors. Attachment based theories focus on these defensive mechanisms and inadequate attempts of emotional regulation, in order to propose an appropriate treatment for borderline personality disorder. [ABSTRACT FROM AUTHOR]

Résumé Le trouble de l’attention avec ou sans hyperactivité est un trouble neurodéveloppemental sous-tendu par des déficits cognitifs. Le diagnostic différentiel reste complexe chez l’enfant. En effet, le déficit attentionnel, l’hyperactivité et l’impulsivité sont communs à d’autres pathologies et sont notamment retrouvés en phase prodromique de la schizophrénie infantile. À travers une revue de la littérature internationale, nous avons tenté d’extraire certaines spécificités comportementales, développementales et cognitives permettant de distinguer ces deux troubles de manière précoce. L’ensemble des données montre la difficulté à établir le diagnostic différentiel, au risque de proposer une intervention thérapeutique inadaptée. La distinction entre les deux troubles ne semble pouvoir se réaliser qu’à la condition de regrouper un ensemble d’indices autour d’épreuves projectives, d’un nombre restreint de tests cognitifs et d’échelles cliniques comme la CBCL et le K-SADS. Les investigations médicales et le recueil des antécédents familiaux favoriseraient également l’élaboration du diagnostic différentiel. Introduction Attention-Deficit/Hyperactivity Disorder is a neurodevelopmental disease underlaid by cognitive deficits. Establishing an Attention-Deficit/Hyperactivity Disorder diagnosis in children is difficult, because attention symptoms, hyperactivity and impulsivity are common to several other pathologies like childhood-onset schizophrenia. Thus, Attention-Deficit/Hyperactivity Disorder can be considered in literature like a prodromal symptom of childhood-onset schizophrenia. Objectives This paper is meant to show the complexity of the differential diagnosis of Attention-Deficit/Hyperactivity Disorder and childhood-onset schizophrenia in prodromal phase, two pathologies sharing symptomatic connections. By investigating their behavioral, developmental and cognitive similarities and dissimilarities, we bring to light specific indicators enabling to distinguish among them as part of a differential diagnostic approach. Methods The field's international literature has been critically reviewed using ScienceDirect, Google Scholar, PubMed and Cairn Info. Results It seems difficult to isolate behavioral, developmental or cognitive indicators specific to each pathology. Furthermore, neuropsychological evaluations appear to provide little in favor of an easy discrimination between Attention-Deficit/Hyperactivity Disorder and childhood-onset schizophrenia. However, the combined use of some of the neuropsychological tests and projective testing, the use of CBCL and K-SADS questionnaires, or social cognitions investigations could provide valuable clues when establishing the differential diagnosis. Finally, psychopathological family antecedents and pediatric investigations could contribute to differentiate ADHD and childhood-onset schizophrenia. Conclusions Differential diagnosis between Attention-Deficit/Hyperactivity Disorder and childhood-onset schizophrenia in prodromal phase requires multiple investigations in the medical and psychological domains to avoid confusion. [ABSTRACT FROM AUTHOR]

Résumé Certains rescapés de noyade témoignent d’un vécu paradoxalement élationnel, caractérisé par une accélération apparente des pensées et une vision panoramique de leur vie. Cette énigme fut discutée par de nombreux médecins et psychologues au cours du xix e siècle. Le philosophe Victor Egger a analysé ce « moi vif » déclenché par l’idée d’une mort imminente dans une réflexion sur les exaltations de la pensée, de la perception et de la mémoire dans les rêves et sous l’effet de drogues. À partir d’un témoignage de quasi-noyade, recueilli par la méthode de l’entretien d’explicitation, nous interrogeons l’actualité de ce débat au regard d’une clinique du psychotraumatisme. Les recherches contemporaines sur les expériences de mort imminente suggèrent que, malgré leurs caractéristiques dissociatives, ces vécus solliciteraient des mécanismes de survivance qui, à court et à long terme, protégeraient des retentissements psychiques d’une confrontation avec la mort. Objectives Medical and psychological nineteenth century literature included reports of strange subjective experiences from people who survived drowning. Instead of being traumatic, this life-threatening situation was sometimes experienced as a paradoxically positive moment, with an apparent acceleration of thoughts and a panoramic review of life. This experience was discussed by several famous figures of French psychology: Hyppolite Taine, Théodule Ribot, Charles Féré, Paul Sollier, Henri Piéron, Henri Bergson, Henri Wallon, etc. This topic was part of a larger discussion on the “exaltations” of thought and memory, and compared with dreams, experiences at the hour of death, and altered perceptions under psychoactive drugs (i.e., opium). In 1896, the French philosopher Victor Egger developped a psychological understanding of these experiences under the name of “live self”. His papers, first published and discussed in the Revue philosophique de la France et de l’Étranger, launched the recognition of what is now called near-death experiences (NDE). But there is subtle differences in the way this object was studied and understood when comparing it to current debates, divided between spiritualist and neuro-reductionist approaches. We explore what we could learn about this enigma when bringing together past and present literature. Methods After a literature review of old French psycho-medical literature on the concept of “live self” and its sources, we analyzed a contemporary case collected through an elicitation interview. This case study is then discussed both through a clinical analysis, and in a comparison with current interpretations of NDE related to drowning. Results In our case study, the subject fell in water and believed, during this short period of time, that it was the end of his life. Then he experienced pragmatic thoughts about how to rescue himself from this danger, prospective thoughts about how his death will be announced and received, and retrospective thoughts about important autobiographical memories. Furthermore, he ignored pain, developed automatic movements, focused his senses, and felt quiet and peaceful. All these aspects disappeared only seconds later when he realized he could easily swim. This experience had relatively few aftereffects on him, as he kept fearing death and did not endorse a belief in afterlife. This case both fits with patterns described in the old literature, and contradicted the “Moody syndrome” currently defining what is a typical NDE (for instance, no out-of-body experience in this case). The subject did not developed posttraumatic stress disorder or other symptoms relative to psychotrauma. This suggested that this experience may be adaptative and help to prevent the consequences of a confrontation with death. Comparison with experiences occurring in various circumstances show similar phenomenology and aftereffects. Conclusions The study of the “live self” of drowning survivors was once a interesting topic for psychology and medicine, but was latter lost sight, until its rediscovery under the umbrella term of “near-death experiences”. Testimonies of such experiences can still be collected and analyzed qualitatively and quantitatively. Psychological and neurological hypotheses about the triggers of such experiences let room for a psychodynamic approach in which the fright of annihilation activates a special psychosomatic circuit. This reaction may be adaptive both because it helps the person to practically save himself/herself from a life-threatening situation and because it may prevent, even long term, the clinical aftermath of such a potentially traumatic event. [ABSTRACT FROM AUTHOR]

Résumé Connu internationalement pour sa découverte des neuroleptiques, Jean Delay (1907–1987) a aussi consacré une partie importante de ses travaux à la mémoire. Sa thèse de médecine sur les astéréognosies, où il a étudié les troubles de la reconnaissance par le toucher, est prolongée quelques années plus tard par sa thèse de philosophie, sous la direction de Pierre Janet, sur les dissolutions de la mémoire. Dans cette thèse, il propose une distinction entre les amnésies neurologiques et psychiatriques, en s’appuyant sur le concept de mémoire sociale forgé par Maurice Halbwachs. Cette question de la mémoire connaît un nouveau développement dans son œuvre littéraire avec la publication des quatre tomes d’ Avant mémoire . Dans ces ouvrages de sociobiographie, Jean Delay met en récit la vie de ses ancêtres maternels du Paris des Valois à celui de Napoléon III, en exhumant des documents d’archives et des actes notariés. Cette œuvre a été mise en parallèle avec celle de Marguerite Yourcenar dont Jean Delay fut le parrain silencieux à l’Académie française. Le cheminement personnel et psychologique de Jean Delay apparaît en filigrane au long de cet article. Known worldwide as the discover of neuroleptics, Jean Delay (1907–1987) dedicaded an important part of his work to memory. First his medical thesis entitled astereognosies is focused on the touch disorders. This work has been followed by a thesis of philosophy under the leadership of Pierre Janet, about memory disorders. Jean Delay proposed a classification of neurological and psychiatric memory disorders taking heed to Maurice Halbwachs’ work on collective memory. And the end of his life, as a writer, Jean Delay led an ambitious project. Thanks to his researches in French national Archives, he published in four volumes the history of his maternal ancestors from XVIth to XIXth century. This work has several connections with two of Marguerite Yourcenar's books: Dear Departed: A Memoir and How Many Years: A Memoir. Jean Delay supported the election of Marguerite Yourcenar at L’Académie française, the first woman to be elected at the prestigious French institution. Psychological traits of Jean Delay are also drawn in this paper. [ABSTRACT FROM AUTHOR]

Résumé Applicable aux salariés du régime général et du régime agricole et souvent, à d’autres bénéficiaires (stagiaires, personnes en réinsertion ou réadaptation professionnelle, demandeurs d’emploi se rendant à un entretien d’embauche…), la législation concernant les accidents du travail et maladies professionnelles est complexe, d’autant que les définitions de « consolidation » et d’« état antérieur » se différencient de celles applicables en droit commun. Dans cet article, nous détaillons le cadre indemnitaire des accidents du travail et maladies professionnelles pour mieux expliciter la place qu’y tiennent les troubles psychiques. Puis, après avoir rappelé les notions d’invalidité et d’affection de longue durée au titre de l’assurance maladie, nous précisons les dispositions expertales des contentieux généraux et techniques de la Sécurité sociale. Applicable to employees and to other beneficiaries, legislation on occupational accidents and diseases is complex, especially because the definitions of “consolidation” and “prior state” differ from those applicable in common law. In this paper, we detail the compensation for occupational accidents and illnesses in order to clarify the place of mental disorders in this system. Then, after recalling the notions of long-term disability and long-term sickness insurance, we specify the general and technical litigations. [ABSTRACT FROM AUTHOR]

Résumé L’évaluation des psychothérapies, pour des raisons ayant trait à la fois au respect de règles de santé publique et à l’amélioration de nos connaissances et de nos pratiques, est devenue une étape incontournable. L’efficacité des psychothérapies, et particulièrement des Thérapies Comportementales et Cognitives (TCC), est aujourd’hui largement documentée dans le traitement des épisodes dépressifs et dans la prévention de leurs rechutes. Les travaux récents portent leurs efforts sur l’amélioration des prises en charge afin d’optimiser encore le gain en termes de prévention de rechutes. C’est dans ce cadre que la démarche MBCT prend toute sa place. Certains auteurs ont montré qu’adjoindre une démarche MBCT améliorait encore le gain en termes de rechute après une TCC auquel le patient avait été répondeur (Vittengl et Jarrett, 2015) lui permettant d’améliorer sa qualité de vie. En revanche, la question du pourquoi elles fonctionnent, dans quelles conditions, pour quels individus particuliers ainsi que l’identification des mécanismes et processus de changement sont encore très d’actualité. Pour ce faire, l’évaluation de l’effet d’une pratique en MBCT a utilisé à la fois des mesures se voulant directes (auto-questionnaires) et des mesures plus indirectes du changement (épreuves neuropsychologiques, mesures psychologiques, techniques d’imagerie cérébrale, etc.). Cette communication se propose de faire le point sur ces mesures, les résultats qu’elles ont apportés et les hypothèses qu’elles ont soulevées respectivement dans la littérature internationale de la dépression unipolaire. The assessment of psychotherapies, for reasons related both to the respect of public health rules and to the improvement of our knowledge and our practices, has become an unavoidable stage. The effectiveness of psychotherapies, and particularly of Cognitive and Behavioral Therapies (CBT), is now widely documented in the treatment of depressive episodes and in the prevention of relapses. Recent work focuses on improving care to further optimize the gain in relapse prevention. It is within this framework that the MBCT approach takes its place. Studies have shown that joining an MBCT approach further improves the gain in relapses after CBT to which the patient had responded (Vittengl et Jarrett, 2015). On the other hand, the question of why they work, under what conditions, for which particular individuals and the identification of the mechanisms and processes of change are still very current. In order to do this, the evaluation of the effect of a practice in MBCT used both direct measures (self-questionnaires) and more indirect measures of change (neuropsychological tests, psychological measures, brain imaging, etc.). The purpose of this paper is to review the results of these measures, the results they have produced and the hypotheses they have raised in the international literature on unipolar disorder. [ABSTRACT FROM AUTHOR]

Résumé Dans cet article, nous abordons les voies de passage existant entre les différents cadres juridiques de réparation du dommage précédemment détaillés. Alors qu’en droit commun une personne blessée ne saurait être indemnisée doublement pour le même dommage, l’indemnisation peut parfois être obtenue selon plusieurs systèmes sollicités d’emblée ou séquentiellement. Nous détaillons en premier lieu les cadres indemnitaires déployés au profit des personnes victimes d’attentat avant d’aborder les apports de la commission d’indemnisation des victimes d’infractions. Nous précisons ensuite les avancées de la jurisprudence concernant le passage de la réparation forfaitaire à la réparation intégrale du dommage, sous conditions, au profit des salariés, des fonctionnaires et des militaires. Enfin, nous évoquons les voies d’indemnisations spécifiques concernant le droit assurantiel, la prise en charge du handicap, et les dispositions des commissions de conciliation et d’indemnisation statuant en cas d’accident médical avec ou sans faute. In this paper, we discuss the existing pathways between the different legal frameworks of psychic repair. If an injured person cannot be compensated twice for the same damage, compensation can sometimes be obtained according to several systems solicited from the outset or sequentially. First, we detail the compensation frameworks for the victims of attacks before discussing the contributions of the commission for the compensation of victims of crime. We then point out the contributions of the case-law concerning the transition from flat-rate compensation to full compensation for damage, under conditions, for the benefit of employees, civil servants and soldiers. Lastly, we discuss the specific compensation possibilities considering legislation of insurance, disability, and medical accident. [ABSTRACT FROM AUTHOR]

Résumé La recherche a montré que pour différents troubles anxieux, une seule session d’entraînement attentionnel permet la modification du biais ainsi qu’une diminution de la vulnérabilité émotionnelle. Les méta-analyses révèlent cependant que la taille d’effet pour les symptômes reste faible, même si l’on augmente le nombre des sessions d’entraînement. En ce qui concerne la dépression, les résultats semblent indiquer que l’entraînement attentionnel serait efficace pour des individus ayant un faible niveau de dépression. Finalement, quel que soit le trouble émotionnel traité, les faiblesses psychométriques du paradigme de détection de sonde ainsi que les problèmes de compliance au traitement manifestés par certains patients incitent les chercheurs à proposer d’autres paradigmes qui pourraient être mieux acceptés par les patients dans le contexte d’une intervention thérapeutique. Introduction According to the theoretical models in cognitive psychopathology, the susceptibility to develop an emotional disorder is causally related to the presence of cognitive biases in the information treatment process such as attention, memory and interpretation biases. Researchers are collecting data supporting the idea that it is possible to modify the cognitive biases and the clinical symptoms as well. The present paper focuses on the modification of attentional bias and symptoms in both anxiety disorders and depression. Method After a brief recall about the nature of attentional biases in anxiety and depression disorders, the article offers a synthetic review of the recent literature on attentional bias modification (ABM) in these mental disorders. First, it explains and debates the methodology mostly employed in this domain. Secondly, it presents the main results with a critical viewpoint especially on the therapeutic interests of these findings by answering a series of questions relevant for the clinical practice. Results In anxiety disorders, the attentional bias selectively favors information that is the most threatening for the trouble. The attentional bias in depression is characterized by a preference toward negative information and is also likely to have an absence of bias for positive information compared to healthy subjects. The attentional bias is most often modified using the so-called dot probe task. However, poor psychometric properties have been now repetitively reported. What are the effects of attentional bias modification on anxiety disorders? The research showed that only one session of ABM is sufficient to modify the bias toward threat and to reduce the emotional vulnerability when people are exposed to stressful situations. These findings have been reported for different anxiety disorders and in adults, adolescents and children. Can the attentional bias modification be envisaged as a therapeutic intervention of anxiety disorders? To answer to this question, patients have been exposed to several ABM sessions. Furthermore, a variety of outcomes measures (subjective, behavioural and physiological) have been taken. The researchers reported a modification of the attentional bias and an improvement of a variety of clinical symptoms. The results of one meta-analysis revealed that more ABM sessions lead to a more extended bias modification. However, another meta-analysis failed to show that a more extended bias modification leads to a greater improvement of the clinical symptoms. This report puts forward the need to enhance our knowledge on the causal relationship between the attentional bias and clinical symptoms. More recently, researchers have developed ABM training at home or via smartphone but the results are mitigated. Is it useful to combine the modification of attentional bias to another clinical intervention to treat anxiety disorders? A few studies have been conducted and even if some of them reported positive findings, overall, the results are reserved. Further, given the number of dropout reported, the effectiveness of the current ABM paradigm in a real-world setting is questionable. What are the effects of attentional bias modification on depression? A few small studies on ABM for depression have been published. Researchers found that ABM sessions lead to a reduced bias for negative stimuli but it is likely that this is only for individuals suffering from a low level of depression. The research on ABM in depression seems to be more successful in the use of ABM as a means to prevent the depressive relapse. Conclusion The ABM paradigm seems to be efficient to treat anxiety disorders even if its capacity to improve the clinical symptoms remains small. In depression, its efficiency remains to be established. So, researchers are now trying to alleviate the use of the current ABM paradigm or to innovate new paradigms to make ABM more exploitable in the context of a therapeutic treatment. [ABSTRACT FROM AUTHOR]

Résumé Le terme « capital social » est un concept à la fois géographique, politique, économique et sociologique, basé sur le principe d’un réseau de relations interpersonnelles. L’association entre capital social et santé mentale est étudiée en tant que facteur modulateur/explicatif de différence et de variation des états de santé des personnes d’un groupe, ainsi que pour son impact sur la prévention, le développement et le procès psychosocial de rétablissement. Le capital social semble jouer un rôle particulièrement important dans l’intégration des immigrants, qui présentent, à leur tour, une vulnérabilité accrue à la maladie mentale liée à des facteurs de stress psychosociaux. Dans cet article nous allons discuter de l’utilisation de ce concept dans l’étude des facteurs environnementaux de maladie mentale et, notamment, de la nécessité d’adaptation de ses indicateurs en fonction du contexte et des populations étudiées. The concept of social capital is useful to study the impact of the interpersonal relationships/networks on the development, outcome, prevention and recovery of mental disorders. Among migrant populations, it seems to play a protective role in mental health, associated to better social support, resilience and less exposure to discrimination. In this paper, we will present the current data on this subject. Then we will discuss the use of this concept in the study of environmental risk factors of mental disorders and the need to construct contextual indicators, especially in minority groups. [ABSTRACT FROM AUTHOR]

Résumé La recherche en psychiatrie de l’enfant et de l’adolescent est soumise à de nombreuses contraintes qui freinent sa créativité et son développement. Elles sont de nature politique, idéologique, administrative mais aussi intrinsèquement éthique et morale. C’est le sujet même de la recherche : l’enfant en situation de vulnérabilité et de handicap qui est possiblement à l’origine de ces contraintes. Il existe de plus une opposition entre chercheurs, services universitaires et praticiens de secteurs. Pour faire avancer la recherche, il faut penser des protocoles qui respectent l’éthique des praticiens et répondent à des manques dans la pratique de terrain. Dans cet article, nous présentons deux exemples d’études cliniques multicentriques conçues dans cette perspective et qui ont permis de répondre à des questions dans des manques autour des pratiques. Le résultat de l’étude de leur impact en termes d’évolution des représentations de la recherche clinique chez le praticien de terrain montre que penser des recherches cliniques qui s’adaptent aux besoins de la pratique de terrain peut être une chance pour notre discipline. Research in child and adolescent psychiatry is subject to many constraints that inhibit its creativity and development. They are political, ideological, administrative but also intrinsically ethical and moral. It is the topic of the research itself that is possibly at the origin of these constraints: the child in a situation of vulnerability and handicap. There is also opposition between researchers, academic services and sector practitioners. To promote research, protocols respecting the ethics of practitioners and responding to gaps into the field must be considered. In this paper, we present two examples of multi-centric clinical studies designed from this perspective and which allowed answering questions in shortcomings around the practices. The result of the study of their impact in terms of the evolution of representations of clinical research in the field shows that thinking hypothesis; design and methods of clinical research that adapts to the needs in the field practice can be an opportunity for child and adolescent psychiatry. [ABSTRACT FROM AUTHOR]

Résumé Le trouble de conversion constituerait-il un trouble à part ? Vécu comme une réalité par le patient, l’absence de signes « objectifs » à l’examen l’a longtemps fait considérer comme une « pathologie sans substrat ». Or, si la clinique de ce trouble est bien connue, sa compréhension précise reste sujette à interprétation et les mécanismes exacts qui le produisent sont encore mal compris. Ainsi, le fait de ne pas retrouver de lésion explicative dans le cerveau exclut-il la possibilité d’un dysfonctionnement au sein de ce même organe ? On qualifie bien souvent ce trouble de « maladie de l’imagination ou de la volonté », mais au final, on connaît peu de chose sur le fonctionnement cérébral du mouvement volontaire et des représentions mentales dans le trouble de conversion. Alors, dans cette optique, quel pourrait être l’apport des moyens « modernes » d’investigation tels que l’imagerie fonctionnelle ? La mise en évidence d’anomalies fonctionnelles dans le cerveau ne permettrait-elle pas d’ouvrir de nouvelles perspectives théoriques pour ces patients ? L’imagerie fonctionnelle a permis d’explorer des mécanismes plus complexes, jusqu’à présent peu accessibles (émotions, états affectifs, volition, imagerie mentale, processus inconscients), et nous proposons dans cette communication de montrer comment, à l’aide de ces techniques, une pathologie considérée comme un diagnostic d’exclusion et de trouble sans substrat peut être abordée différemment du fait d’explications neurophysiologiques « nouvelles ». Are the conversion disorders beyond medical disorders? Lived as a reality by the patient, the absence of “objectives” signs at the clinical examination have for a long time considered these conversion disorders as “pathologies without substrates”. However, if the clinic of these disorders is well known, its precise understanding remains subject to debate and the exact mechanisms that produce it are poorly understood. Does the fact that explanatory lesions in the brain are not found, exclude the possibility of functional abnormalities in this organ? It is often called these disorders “disease of the imagination or the will”, but in fact, we know little about the brain functioning of voluntary motor movement and mental representation in conversion disorders. So with this in mind, what could be the contribution of “modern” techniques of investigations such as functional imaging? Would the identification of functional abnormalities in the brain allow opening new theoretical perspectives for these patients? Functional imaging has explored more complex mechanisms considered some years ago as inaccessible (e.g. emotions, affective states, volition, mental imagery, unconscious processes), and we propose in this paper to show how, using these techniques, a pathology considered as a diagnosis of exclusion and a disorder without substrate can be approached differently through “new” neurophysiological explanation. [ABSTRACT FROM AUTHOR]

Résumé Afin d’aider les parents de jeunes enfants avec un trouble du spectre de l’autisme (TSA) à faire face au stress qu’engendrent les difficultés liées à l’autisme de leur enfant, un programme psychoéducatif de formation a été élaboré. Ce programme francophone de douze séances de deux heures et trois visites au domicile, intitulé « L’A.B.C. du comportement de l’enfant ayant un TSA : Des parents en action ! », est basé sur l’analyse appliquée du comportement. Il a été évalué auprès d’un groupe pilote afin d’en déterminer la validité sociale et l’efficacité. Les résultats de six parents d’enfants âgés entre quatre et six ans montrent une augmentation des connaissances sur les TSA et les pratiques éducatives en fin de programme. Une amélioration du comportement de l’enfant a également été observée pour quatre parents. Les familles sont satisfaites du programme, surtout celles ayant un enfant avec TSA et retard de développement. Objectives Autism spectrum disorders (ASD) are not only affecting the development of the child diagnosed with this disorder, but also their entire family. Parents of children with ASD face many challenges that affect their well-being and family's quality of life. These parents need support to understand their child's diagnosis, to face maladaptive behaviors and to promote skill acquisition. Parent training programs (PT) are known to increase parents’ knowledge and skills in these areas. The potential benefits for the families are reduced stress for parents, improvements in the child's development and better parent–child interactions. Unfortunately, a few structured PTs are available to French-speaking families with an ASD child. In order to provide them with this type of intervention, we developed a French parent training named “L’A.B.C. du comportement de l’enfant ayant un TED/TSA: Des parents en action!” and based on applied behavior analysis. The application and evaluation of this new intervention technique follow the recommendations for research studies on psychosocial interventions for individuals with ASD. Therefore, an initial efficacy study has been conducted to establish the promise of this PT. This paper presents the results of the first group of parents. Methods A group of ten parents attended 12 bimonthly sessions of 2 h and three individual home visits. They progressively learned behavioral intervention strategies to face disruptive behaviors and enhance their children's communication and adaptive skills. Six parents (three couples) of three children with ASD (ages 4–6) participated in this study. Measures of efficacy were taken pre- and post-treatment assessment and at a 3-month follow-up: parent's level of knowledge in ASD and behavioral intervention strategies, parenting stress, parent's number of depressive symptoms, children's adaptive functioning and problem behaviors. Parents were also asked for their opinion on the social validity of the program: adequacy of the objectives, acceptability of the methods and satisfaction of the results. Results Parents have significantly improved their knowledge in ASD and behavioral intervention strategies in post-treatment. Four parents reported an improvement in their child's behavior at the end of the PT, but for the two others, the PT was not enough to manage the behavior problems of their son with an Asperger Syndrome. They suggest a specific PT for parents who have a child with Asperger syndrome. All of the participants evaluated the methods used as acceptable and the objectives targeted by the PT as important and necessary for parents of children with ASD. Moreover, all of them recommended this PT to others families and considered continuing using the behavioral intervention strategies they had learned. Conclusions This new French PT program seems to be a feasible and promising intervention for parents of young children with ASD and developmental delay. The content of the PT will be refined and tested on a larger group before being manualized. [ABSTRACT FROM AUTHOR]

Résumé Prévenir la récidive suicidaire chez l’adolescent est l’une de nos préoccupations lorsque nous recevons un jeune patient dans les suites d’une tentative de suicide. En effet, la récidive suicidaire reste importante, comprise entre 14 % et 28 % dans l’année suivant la tentative de suicide étudiée. Dans ce but, les recommandations préconisent un suivi suffisamment long et valorisent le maintien du lien avec le service de soins, ce qui est loin d’être aisé auprès d’adolescents qui n’ont souvent aucune demande de soins. Cette communication présente tout d’abord brièvement trois études menées auprès d’adolescents suicidants. La première étude porte sur le poids de la récidive suicidaire sur le devenir des adolescents ; la deuxième porte sur l’impact de ne plus être joignable par les équipes de soins à un an d’une tentative de suicide et la troisième sur les modalités d’utilisation des média par les adolescents suicidants. Ces études convergent finalement vers une idée : l’intérêt de la mise en place d’un dispositif de veille en postvention. Enfin, le dispositif de veille MEDIACONNEX est présenté, dispositif basé sur l’envoi de messages par SMS ou tout autre média qui sera évalué à partir d’un essai contrôlé randomisé. Preventing suicidal recurrence in adolescence is one of our concerns when we receive a young patient in the aftermath of a suicide attempt. Indeed, suicidal recurrence remains significant, between 14 % and 28 % in the year following the suicide attempt studied. For the purpose, the French recommendations advocate a sufficiently long follow-up and value the maintenance of the link with the care service, which is sometimes difficult with adolescents who often have no demand for care. This paper presents three studies of suicidal adolescents, which have in common a convergence towards an idea: the interest to set up a monitoring system in postvention. Objectives (1) To describe psychosocial outcomes of SAers and the weight of recurrence on these outcomes; (2) to study the impact of losing contact with caregivers during the year following SA; and (3) to study how young SAers use means of communication, and perceive social support they receive and their health-related quality of life. Materials and methods Three researches were carried out on adolescent SAers at Nancy university hospital, one of them in association with Strasbourg university hospital. Overall, 309 SAers participated in the first study: they were evaluated at time of SA and 10 years after SA. The second study concerned the correlation between a loss of contact with caregivers and SA recurrence occurring between 1 to 10 years after the initial SA of 249 young patients. The third study focuses on how 58 SAers use means of communication, and perceive social support they receive and their health-related quality of life. Results As an adult, the psychosocial situation of young SAers is impaired, especially for those who have a recurrence of SA during the year after index SA. The risk of recurrence increases in the 10 years following index SA for early SAers (OR = 2.3; 95 % CI = 1.1–4.9), and in the year following index SA when contact has been lost with caregivers (HR = 2.8; 95 % CI = 1.4–5.5). SAers preferentially use SMS to “keep in touch” with relatives and they assess on a less positive note than peers their social support and health-related quality of life. Finally, they would agree to receive SMS messages from caregivers and underline the interest of including a support message. Conclusion and perspectives SA recurrence is associated with poorer psychosocial outcomes and with higher risk of SA over the longer term. A loss of contact with caregivers 1 year after SA of inclusion was also associated with recurrence. Communication devices focusing on keeping in touch with SAers have been developed for adults over the last decades. Therefore, we developed a monitoring device based on SMS sending in order to prevent SA recurrence which will be assessed through a randomized controlled clinical trial. [ABSTRACT FROM AUTHOR]

Résumé L’article propose une revue de la littérature sur les facteurs de protection, de vulnérabilité et d’adaptation familiaux face à la consommation de substances psychoactives de l’adolescent. L’introduction permet de rappeler les dimensions familiales considérées comme protectrices d’un trouble addictif à l’adolescence. La première partie est consacrée aux facteurs de vulnérabilité familiaux impliqués dans le développement d’une conduite addictive. La seconde présente les impacts cognitifs, émotionnels et comportementaux induits par l’addiction d’un membre de la famille sur son entourage et présente les différentes stratégies d’adaptation mobilisées par les proches du consommateur. La conclusion permet d’ouvrir une réflexion sur de nouvelles perspectives de recherches en lien avec la pratique des psychologues cliniciens. This literature review synthesizes what is known about family vulnerability and adaptation factors towards substance use in adolescents. The introduction resets individual risk factors, such as aggressiveness, impulsiveness, sensation and novelty seeking, and psychopathological comorbidity frequently associated with addictive disorders (anxiety and depression). Peer influence plays an important role in drug experimentation and consumption in adolescence. The context of protective family dimensions is also described. Thus, parental supervision of the young, clear family rules, low levels of family conflict, as well as good communication between the young and his parents are protective dimensions with respect to substance consumption. The first part of this paper deals with family vulnerability factors involved in the development of addictive behaviors. There seem to be structural and functional differences in consumer families. Teenagers living in a single-parent family, or with divorced parents, or sharing the daily life of a parent dependent on psychoactive substances, seem more attracted by substances. Family dynamics may be dysfunctional, with problems noted including low levels of cohesion, poor adaptability and poor communication between family members. A low level of cohesion implies low attachment bonds between members. Low adaptability seems to be a strong predictor of teenagers’ addictive behaviors. The nature of relationships between family members is problematic: we can note the presence of “intergenerational coalition”, “perverse triangulation” and often a poor quality relationship with the fathers. These families also show difficulties to elaborate the process of separation and individuation, behavior allowing the teenager to aspire to independence, even if dependence to the family remains. Communication skills of consumer families seem to be poor and associated with high intensity conflicts. Mothers of dependent patients would express more hostile feelings towards consumers. To date, studies of families that have adolescents with drug problems have focused on family vulnerability factors, involved in the development of addictive behaviors, but few researchers have assessed the impacts of a consumer's addiction on his relatives. Therefore, the second part concerns the cognitive, emotional and behavioral impacts of a consumer's addiction on his relatives, and presents the different coping strategies used by relatives. Addiction causes chronic stress to the environment that could be a source of physical (e.g. sleep or appetite disturbances) and psychological (anxiety and depression) disturbances, as well as a feeling of burden. On the emotional level, negative valence feelings prevail (e.g. shame, fear, anger, sadness, guilt…). Faced with this aversive situation, relatives try to adapt by using coping strategies. There are different types of coping and some seem more appropriate, allowing an increase in physical and psychological well-being. Efficiency of coping seems to depend on the relatives’ understanding of the addiction, namely that addictions are complex, uncontrollable and joining on the long term. This review opens new research perspectives related to the practice of clinical psychologists in families that have an adolescent with substance use disorders. We could investigate individual parental coping in a multidimensional and situational prospect. Moreover, further studies could examine the couples’ adaptation strategies by investigating dyadic coping. Coping efficiency could then be analyzed and discussed with regard to family dynamics and the psychological distress perceived by the parents. [ABSTRACT FROM AUTHOR]

Résumé L’Algie Vasculaire de la Face (AVF) se manifeste par des accès douloureux paroxystiques fréquents et invalidants. L’intensité de la douleur est exceptionnellement sévère. Dans l’AVF, des manifestations psychiques ou comportementales sont retrouvées en cours de crise, avec une sémiologie pour le moins singulière, voire extrême. Ce travail phénoménologique veut tenter de répondre à la question : « Qu’est-ce que cela vous fait d’avoir une crise d’AVF ? » en utilisant la méthode dite d’entretien d’explicitation des vécus conscients. Trois axes phénoménologiques se différencient : (1) une altération de l’Être-au-monde attestée par une impression de restriction physique et d’enfermement insupportable, imposé, sans échappatoire ; (2) une altération de l’Être-à-soi qui va de la déformation à la dissolution ; (3) et une altération de l’Être-à-l’autre allant de la solitude impérative à la seule acceptation d’une présence sans mots. Objectives Cluster headache (CH) is a rare disease (1 to 3/1000), predominant in men (sex ratio: four men/one woman) and characterized by frequent very painful paroxystic attacks occurring sometimes eight times by day. CH is a disease without lesion and impairs the quality of life of patients. Attacks occur only on the same hemiface and can last from 15 minutes to 3 hours. The pain is particularly severe and a frequent and extreme psychiatric symptomatology is observed during the attacks. Treatments are rare and not always efficient: sumatriptan, oxygen, LSD, psilocybin. In this paper, we try to answer to the question: “What does that make you to have a cluster headache attack?” using elicitation interview developed by Vermersch. Patients and methods Ten patients have been interviewed using elicitation interview (EI) (40–50 min for one interview). All these patients (seven men's and three women's) T suffer from chronic or episodic CH, with a mean age of 43 years. The patients come from the Lariboisière hospital (Paris), and more precisely from the center of headache urgency. EI allows describing the pre-reflexive consciousness contents. The method is described in Balzani et al., and in Petitmengin et al. (see bibliography). Data analyses were performed using Interpretative phenomenological analysis (IPA). Results From the EI, we have distinguished three phenomenological axes, following Heidegger's philosophy: (1) An alteration of being-to-the-world with a strong unbearable feeling of imprisonment, and physical restriction. At the same time the patients present a stereotypical and automatic behavior with few motor schemes and escaping strategies. When pain arises, they want to leave and to go very far. Aggressive behaviors frequently occur. Sometimes, the patients are not able to perform the sumatripan injection, due to a motor inhibition. Some patients try to do autohypnosis or other methods to resist to the pain. (2) An alteration of being-to-the self, going from the corporal distortion to the body dissolution. At the onset of symptoms, the patient does the experience of physical deformation, particularly of the face, with strong vegetative symptoms. The patient is not able to control corporeal manifestations: tears, mad thinks, incoherent projects in order to stop the crisis. Some patients want to remove the part of their body where the pain is the most intense (eye, for example). There is a losing of the body limits and a loss of the time orientation. In many cases, the pain is unbearable and patients want to commit suicide. At the extreme, the sensation of self seems destroyed, and some patients evoke an experience similar than Near Death Experiences, or describe an experience of swaying in emptiness or imminent death. (3) An alteration of being-to-the-other, going from the imperative solitude to the acceptance for a presence without words. Solitude is the most experience for the patients. They cannot accept anybody. Another person is unbearable, because asking questions about the crisis. In the same time, the patient is scared of this solitude since he is not able to speak about his painful experience. In summary, the structure of the self is altered, and thinking is completely disturbed. The experience of time and space is modified and a pragmatism is a consequence of this intense pain. During the crisis, pain is central and the patient lives a kind of dissolution, near death: a self-dismantling. Conclusion The EI have allowed us to describe precisely the painful experience of subjects with a cluster headache. This experience is very rich and very intense. EI, as a phenomenological method, is a very useful method to describe more precisely the symptomatology of a disease, because it pays attention to the effective experience of the pathological flesh, as compared to the pathological body. [ABSTRACT FROM AUTHOR]

Résumé Fort de son histoire dans l’accueil et la prise en charge de personnes dangereuses, le centre hospitalier de Cadillac a créé une unité singulière dans le paysage hospitalier français : l’Institut Psycho-Judiciaire. Les passages à l’acte dangereux sont récurrents, avec parfois des conséquences humaines très importantes. Développer les connaissances sur ces problèmes fait partie de l’éventail de réponses à leur apporter. Dans cette optique, l’Institut psycho-judiciaire a pour vocation de développer et de diffuser des informations et des connaissances sur la dangerosité et sur des sujets qui y sont associés. Mieux connaître la dangerosité, c’est aussi mieux la prévenir. Drawing on its experience in welcoming and treating dangerous mentally unstable persons, Cadillac hospital has created a unique unit in the French hospital landscape: the Psycho-Legal Institute. To take the plunge into committing a dangerous act is common, and sometimes these acts have very significant human consequences. Developing our knowledge of these problems is one in a range of ways of reacting to them. In this light, the Psycho-Legal Institute's mission is to develop and distribute information and knowledge concerning human dangerous behaviour and associated subjects. The number of those who stand to benefit from research in this field and the knowledge drawn from it is potentially considerable. Many in France and beyond may be concerned in the Institute's output. Whether it be by reading the paper and digital publications or by monitoring the verbal briefings, a sizable number of healthcare professionals – notably those working in mental healthcare – and agents of justice should find that they have an interest in sharing the information and knowledge emitted from the Psycho-Legal Institute. The list of professionals concerned is very open: doctors, nurses, psychologists, social workers, judges, lawyers, judiciary experts, penitentiary workers, police investigators, etc. Students who plan to train in these professions will also draw great benefit from the Institute making the resulting knowledge readily available. To have a better understanding of dangerous behaviour is also to know how to better prevent it. [ABSTRACT FROM AUTHOR]

Résumé L’image de la guerre ou la guerre de l’image, dilemme fondamental du thème de la journée (introduction de la présidente). Des cinq communications présentées en premier, on retiendra : l’occultation de la violence dans les photographies de la bataille de Verdun, l’effet horrifiant et démoralisant pour le public occidental des scènes atroces diffusées par les terroristes, la distance évitant la culpabilité pour l’opérateur de drone, les apports de l’imagerie cérébrale (amygdale et hippocampe) à la compréhension des mécanismes du trauma et la transformation possible de l’image traumatique dans le rêve de répétition. Ensuite, nous dirons : les médias d’aujourd’hui sont rapides, pénétrants, réalistes et émotionnants; le public peut s’informer (démarche active) au lieu d’être informé passivement ; dès le stade de la perception, l’image de violence fait lever dans le psychisme une marée émotionnelle qui bloque la chaîne des processus cognitifs. L’image de guerre suscite horreur, tristesse et compassion. Toutefois, pour lutter contre la démoralisation, les gouvernants peuvent avoir recours à la censure ou au commentaire glorieux. La forme esthétique du poème de guerre atténue d’ailleurs l’horreur de son contenu. Enfin, le film didactique sur la névrose de guerre peut être éventuellement diffusé au public pour lui montrer que les blessés psychiques sont pris en charge, soignés et réinsérés. Picture of the war, or war of the picture, fundamental dilemma of this seance (presidential introduction). From the five first papers, we shall hold: violence is occulted in the photographies of the battle of Verdun, the horrifying and demoralizing effect on the occidental public of atrocious scenes broadcasted by terrorists, the distance which avoids guilt for the drone operator, the contribution of cerebral imagery (amygdale and hippocampus) to the knowledge of traumatic mechanisms, and the possibility of transforming the traumatic picture in the repetition dream. Then, we shall say: medias of to-day are quick, penetrating, realist and emotionant; the public can inform himself (active gait) instead of being passively informed; as soon as the stage of perception, the picture of violence raises in the psychism an emotional wave that blocks the suite of cognitive process. The war picture arouses horror, sadness and compassion. However, governants can resort to censure or glorious commentary. Anyway, the aesthetic form of the war poem attenuates the horror of its content. Finally, the didactic film on war neurosis are be eventually distributed to the public in order to show him that psychic wounded are taken in charge, nursed and reinserted. [ABSTRACT FROM AUTHOR]

Résumé Première femme médecin-psychiatre à avoir eu, bien avant les années 1920, une expérience et un contact direct avec l’institution psychiatrique à Vienne, puis à Berlin, Helene Deutsch a ensuite entrepris une formation psychanalytique suivie de fonctions psychanalytiques institutionnelles à Vienne, puis – à partir des années 1934 – à Boston. Elle a produit une œuvre riche et controversée qui anime encore les débats sur le féminin, la personnalité, la maternité, l’érotisme dans la psychanalyse et la sociologie contemporaines. First woman who as psychiatric practitioner before 1920, Helene Deutsch began her career in psychiatric institution in Vienne and Berlin. She trained further in psychoanalysis first in Vienne, and in Boston. She also developed formal training for therapists and analysts. She also wrote several famous papers on female sexuality and about women's psychology. [ABSTRACT FROM AUTHOR]

Résumé Presque 20 ans après celle du DSM-IV, la publication du DSM-5 est un événement majeur dans le champ de la psychiatrie. Chaque révision du texte du DSM vise à améliorer la fidélité et la validité des diagnostics psychiatriques et améliorer ainsi son utilité clinique. Le DSM-5 s’écarte sur de nombreux points des éditions précédentes, apportant plusieurs changements concernant la schizophrénie : un abandon des formes cliniques de la schizophrénie en faveur d’une évaluation dimensionnelle des signes et des symptômes, une relativisation de l’importance des symptômes de premier rang ainsi qu’une clarification de la définition des symptômes négatifs, une nouvelle spécification de l’évolution, une clarification du statut nosologique de la catatonie, et une définition plus précise du trouble schizo-affectif délimitant ses contours et le séparant de la schizophrénie et des troubles de l’humeur avec caractéristiques psychotiques. Tous les changements ayant concerné la schizophrénie dans le DSM-5 devraient principalement faciliter son évaluation clinique et sa prise en charge thérapeutique, et constitueraient un champ de recherche visant à mieux comprendre sa pathogenèse. Nous proposons de dresser dans ce travail un portrait des principaux changements introduits dans le DSM-5, traitant plus spécifiquement de la schizophrénie et leurs justifications. Objectives The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was issued almost 20 years after the previous edition, and it was a major event in the field of psychiatry. This new edition of the DSM aimed to improve the reliability of psychiatric diagnoses, to improve its clinical utility, to address problems identified in DSM-IV, and to incorporate new knowledge and understanding accumulated since the earlier version. The aim of this paper is to describe and comment the changes made from DSM-IV to DSM-5 concerning schizophrenia. Materials and methods PubMed and Medline search, Scopus, journal and textbook articles have been accessed for the review of literature on DSM-5 changes related to schizophrenia. Results Several minor but important changes have been made to the schizophrenia diagnostic criteria in DSM-5. The special treatment of Schneiderian first-rank hallucinations was removed because these symptoms have not been found to be specific for schizophrenia. Likewise, the privileged status of bizarre delusions was removed. Classic subtypes of schizophrenia provide a poor description of the heterogeneity of schizophrenia and had limited diagnostic stability and little clinical utility. As a result, all these subtypes were removed. Dimensional assessment of symptoms was added. It can be used for treatment monitoring and planning and the prediction of course and outcome. This change allowed for more specific and individualized assessment of patients, and better understanding of heterogeneity of schizophrenia. Negative symptoms were clarified. Diminished emotional expression and avolition were considered as the two domains of negative symptoms because they better describe distinguishable aspects of negative symptoms. The DSM-5 has also provided a clearer separation between schizophrenia with mood symptoms and schizoaffective disorder. Schizoaffective disorder was explicitly reconceptualized as a longitudinal and not a cross-sectional diagnosis. The relationship of schizophrenia to catatonia was clarified. Catatonia is treated consistently across the DSM-5 manual as a specifier, and the same criteria to diagnose catatonia are utilized across the manual. A new category of “attenuated psychosis syndrome” was added to section 3 (Appendix) of DSM-5 to describe a condition with recent onset of psychotic symptoms in attenuated forms. Demonstrating adequate reliability of the proposed disorder diagnosis was not possible. Therefore, attenuated psychosis syndrome requires further study. Conclusions The etio-pathophysiological nosology of schizophrenia has remained elusive. Changes proposed in the DSM treatment of schizophrenia are relatively modest and the core of the DSM-IV diagnostic criteria is retained. The provision of dimensional assessments with a simple rating scale appears promising and should encourage provision of measurement-based care. These changes should improve characterization of individuals with schizophrenia and facilitate clinical assessment and treatment. In addition, they constitute a research field to better elucidate its nature and understand its pathogenic mechanism. [ABSTRACT FROM AUTHOR]

Résumé Les troubles sémantico-pragmatiques du langage occupent une place ambiguë et discutée dans les troubles du développement de l’enfant. Ils sont considérés par certains (le courant psychodynamique, avec la CFTMEA) comme des symptômes propres à la dysharmonie psychotique. Pour d’autres, ces symptômes font partie des troubles envahissants du développement (DSM-IV). Les logopèdes/orthophonistes le considèrent comme un syndrome à part entière : le syndrome sémantico-pragmatique ou dysphasie sémantico-pragmatique. Ce syndrome correspond à des difficultés de compréhension, de formulation, d’interprétation et de décision, ainsi qu’à un manque d’adéquation pragmatique, rendant le contenu discursif inadéquat et peu informatif. Avec cet article, nous tentons de comprendre les différentes hypothèses diagnostiques tout en essayant de mettre en évidence les repères cliniques qui pourraient nous aider dans le diagnostic différentiel de ces troubles ainsi que dans le choix des orientations et outils thérapeutiques. Cette problématique complexe est illustrée par l’histoire d’un jeune de 13 ans diagnostiqué d’abord « trouble envahissant du développement » puis, dans un deuxième temps, « syndrome sémantico-pragmatique », et enfin, « dysharmonie psychotique ». Objectives Semantic-pragmatic disorder affects the use of language in a social context. However, therapists do not agree upon whether semantic-pragmatic disorder belongs to the autism spectrum or if it is an entirely separate condition. Rapin and Allen first defined semantic-pragmatic disorder (SPD) in 1983 as a language disorder. Confusion surrounds the use of diagnostic terminology in the area of SPD, where neurology, psychology, psychiatry and speech and language therapy converge. Nowadays, the most common definitions of SPD are: language impairment; manifestation of an autistic spectrum disorder; disorder between language impairments and autistic spectrum disorders; multiple complex developmental disorders. Recently DSM-5 has identified a new diagnosis called social communication disorder. This category is characterized by a persistent difficulty with verbal and nonverbal communication that cannot be explained by low cognitive ability. Symptoms include difficulty in the acquisition and use of spoken and written language as well as problems with inappropriate responses in conversation. The disorder limits effective communication, social relationships, academic achievement, or occupational performance. This paper discusses the characteristics of semantic-pragmatic disorder as well as social communication disorder and how to manage them. Its goal is to sensitize children psychiatrists and children psychologists about this problem, to arrive at a more precise diagnosis and to prescribe more accurate treatments. Patient In this article we present a single clinical case based on the story of a young boy called Mark. This case is interesting because at the age of six, Mark was diagnosed with an autistic spectrum disorder. Later on, at the age of eight a new examination pointed to language impairment. As an early teenager, at the age of 13, Mark was reevaluated and diagnosed with a multiple complex developmental disorder. Results Up until today the literature does not provide clinical studies that allow us to differentiate semantic-pragmatic language disorders, disorders of the autistic spectrum and multiple complex developmental disorders. However, after having interrogated speech therapist and clinicians, we have observed clinical individual differences throughout the course of the treatment. Compared to children suffering from an autistic spectrum syndrome, children that exhibit a semantic-pragmatic language disorder seem to have the following characteristics: initially a fascination for details that is less significant but that decreases with time until it finally might disappear; a continuity of ritual behaviors that is initially less significant but that decreases with time until it finally might disappear; a better eye-contact in their relationship with others; a better variability of facial expressions; a better capacity to generalize from what they have learned from a new situation; a weaker requirement of invariance even if the interests might be restraint; no or few stereotypes that diminish strongly with time until they eventually disappear; persevering difficulties in the use of personal pronouns above the age of seven; late, but spontaneous acquisitions of symbolic play and in pretend play. These clinical elements can guide us in our reflections concerning the differential diagnosis. They deserve a deeper understanding about their validity during diagnosis. Conclusions The symptomatology of the semantic-pragmatic syndrome is complex and gives rise to several different diagnostic hypotheses. This points to the importance and necessity of a multidisciplinary evaluation. The complete and detailed medical history of the child's development, the persisting symptoms and the IQ profile are elements for which we have to remain attentive. This is important to guide us in our differential diagnosis and in our treatment. [ABSTRACT FROM AUTHOR]

Résumé Introduction La dépression représente actuellement l’une des plus importantes causes d’absentéisme de longue durée au travail et qui a connu une croissance importante au cours de ces dernières années. L’étude de ce phénomène en milieu hospitalier doit son intérêt à la fois à l’importance numérique du personnel concerné et au polymorphisme des nuisances et des risques encourus. Les objectifs de notre étude étaient d’identifier les caractéristiques socioprofessionnelles du personnel de santé absent pour maladie dépressive et de déterminer les principaux facteurs de risque et les moyens de prévention de ces absences. Patients et méthodes Il s’agit d’une étude descriptive rétrospective, réalisée à la Direction Régionale de la Santé de Sousse (Tunisie) sur une période de cinq ans allant du 1 er janvier 2009 jusqu’au 31 décembre 2013, portant sur tous les dossiers du personnel de la santé du secteur public qui s’est absenté pendant une longue durée pour dépression nerveuse. Résultats Notre étude a porté sur un nombre de 204 personnel de santé répartis en 159 femmes (77,9 %) et 45 hommes (22,1 %). La moyenne d’âge a été de 50,3 ± 7,68 ans. Les services les plus touchés par l’absentéisme pour dépression ont été notamment : les services médicaux (18,6 %), la maternité (14,7 %), l’administration (11,3 %) et les urgences (10,8 %). Au cours des cinq années d’étude, le nombre de congés de longue durée attribués au syndrome dépressif était de 768 congés avec 80 327 jours de travail perdus. Conclusions Les arrêts de travail de longue durée semblent constituer un fléau et ont un impact économique et moral important. Le rôle du médecin du travail reste capital vu sa contribution utile et efficace dans l’amélioration des conditions du travail et la prévention de la maladie dépressive. Depression in the workplace is becoming more common. It is responsible for the upsurge in long-term sick leave. Its prevention requires the improvement of working conditions and the management of burnout. Health workers, faced with suffering, illness, death are subject to significant mental workload. Some authors believe that the mental workload is multiplied by 2–7 among hospital staff. Physical and nervous overload is expressed by psychosomatic and neuropsychiatric manifestations. We conducted a work aimed to study the interactions between depression and professional activity among health care workers in the Governorate of Sousse, Tunisia during five years from 1 January 2009 until 31 December 2013. Data was collected from medical and administrative records accessed at the Regional Commission of long-term sick leave in Sousse. Concerned patients were invited to answer additional questions during consultation. We have attempted to identify the socio-professional characteristics of absentees, and to determine the possible role of working conditions in the decompensation of depression in order to establish preventive measures. Our work is a retrospective descriptive study which surveyed 204 health workers who have obtained a long-term sick leave for depressive syndrome during the study period. The prevalence of absenteeism was estimated to 4.45%. Some employees have submitted more than one sick leave, which raises the number of sick leaves to 768 during the study period. The study population is relatively young, with about 50.9% of absentees aged between 50 and 59 years. A female predominance was noted (77.9% of absentees). Our population was composed mainly of married employees (79.9%) which had, in 88.7% of cases, at least one dependent child. Older paramedics were more affected than any other occupational group. The most affected services were, in descending order, medical, gynecological and obstetric services, administrative services, emergency services, outpatient and finally pediatric services. Most common medical affections were hypertension, diabetes, cancer and rheumatic diseases. Personal history of psychiatric diseases was mentioned by 38% of cases. As pointed by many authors, healthcare workers commonly relate the genesis of their psychiatric disorder to socio-professional conditions. Physical load was declared by 46.1% of cases and metal overload was described by 27.9% of questioned workers. Other common stressing situation was the permanent contact with patients and/or their family. Conflictual relationship with colleagues and/or superiors was declared by 17.6% of cases. It appears from our study that 10.8% of absent for depressive syndrome feel insecure in their work. This feeling seems to be more pronounced in recent years after the revolution in Tunisia (2011). Indeed, the rate of violence against care workers has tripled after the revolution. The most important consequence of this disease is long-term absenteeism which has an expensive cost expressed by economic and social outcomes. In our survey, we found that the absenteeism was 21.57% with 80,327 lost working days which is pretty near to 44 years lost per year of work during the of study period. The analysis of our results showed that the absenteeism indicators are very high and it is urgent to have a real plan of action. This plan primarily affects prevention. The management of depression in the workplace requires a multidisciplinary intervention and better coordination between occupational physician and psychiatrist or psychologist. [ABSTRACT FROM AUTHOR]

Résumé La compréhension de l’anorexie de l’adolescent évolue. Certaines données de la médecine par la preuve permettent de remettre en question les pratiques de terrain centrées sur la séparation avec le milieu familial. Le but de cet article est de retracer l’expérience d’une équipe pluridisciplinaire française de pédopsychiatrie dans la construction des modalités de soins pour la prise en charge de l’anorexie de l’adolescent, de la séparation complète avec le milieu familial vers un cadre de soin sans séparation. La séparation induit des difficultés dans les équipes de soin, chez les adolescents et leurs familles qui sont analysées. La construction progressive d’un parcours de soin sans séparation familiale est décrite et explicitée. Understanding adolescent anorexia evolves. Some evidence based data question the practices centered on the separation with the family used in the field in France. The purpose of this paper is to trace the experience of a French adolescent psychiatry department throughout the construction of changing care conditions of anorexia in adolescents. The treatment evolved from complete separation with the family environment to a structured care without separation. The difficulties faced by teams, families and teenagers at the time of using the device of separation are analyzed. The gradual construction of a care course involving families is described and explained. [ABSTRACT FROM AUTHOR]

Résumé Objectif L’auteur propose dans ce travail une réflexion portant sur l’évolution de l’expertise pénale constatée depuis les 15 dernières années. Ce travail porte plus spécifiquement sur les expertises psychologiques pénales en pré-sentenciel, mais il aborde aussi la question de l’expertise psychiatrique et surtout de l’évolution entre une expertise auparavant centrée sur le diagnostic et la constatation d’une pathologie psychiatrique ou de traits de personnalité spécifiques, vers une évaluation de plus en plus orientée sur la dangerosité « criminologique » et non plus psychiatrique du sujet expertisé. L’auteur examine les orientations politiques et les évolutions souhaitées par les « professionnels ». À travers une comparaison avec d’autres pays et procédures, il s’interroge sur des possibilités d’améliorations. Comment améliorer sa pratique en la mettant en accord avec l’évolution observée durant cette décennie écoulée ? Méthode L’auteur s’appuie sur une revue de la littérature, les différents travaux parlementaires, rapports et auditions publiques, mais également sur son expérience basée sur 140 rapports d’expertises remis pour le compte du TGI, avant d’effectuer une comparaison avec d’autres pays et types de procédures qui permettront d’éclairer certains aspects directeurs du procès et leurs incidences sur la réalisation des expertises psychiatriques, psychologiques, « psychocriminologiques » et leurs évolutions possibles. Conclusions Les différents moments de l’instruction et la place de l’expertise, telle qu’elle y est pratiquée, amènent à envisager une refonte de celle-ci. Conviendrait-il d’établir une distinction entre la dimension purement psychopathologique et l’analyse psychocriminologique ? Il apparaît qu’une refonte en profondeur soit à envisager afin de proposer des réponses appropriées aux questions posées par les magistrats instructeurs. Comment se prononcer quant à un éventuel acte rattaché à une personnalité avant toute déclaration de culpabilité par un tribunal ? L’évaluation psychocriminologique, de plus en plus importante dans les ordonnances, pourrait-elle gagner à être organisée de façon pluridisciplinaire dans des centres spécialisés, et si oui à quel moment de l’instruction cette évaluation pourrait-elle avoir lieu ? En pré-sentenciel ou une fois le jugement rendu ? Objectives This paper intends to bring an opinion concerning the field of psychological and psychiatric assessments in France, how it evolved during the last 15 years and which type of improvements could be made. We focus, in this work, on the presentencial assessment and how this examination changed from an ascertainment of the presence/absence of a blatant psychosis or personality traits to a criminological oriented mission, dealing more with the criminological than the psychiatric dangerousness of the assessed individual. The author will examine the successive political reforms and which changes are called for by practitioners. Through an observation and comparison with other countries and procedures, he wonders about the axis of amelioration and ways to improve his own practice according to the changes observed for the last decade. Methods The author will base his reflection on literature review, parliamentary reports and public audit but also on his own Court Assessment practice which includes 140 reports over 90 cases in order to make a comparison between different countries and to offer proposals about psychological, psychiatric assessments and eventually psychocriminological ones. Results The various stages of the instruction phase and the place dedicated to the assessment and how it is performed led us to think about possible revisions. Should a clear distinction between the psychopathology and the psychocriminology be made? Could a new set of rules and prerogatives be determined in order to offer appropriate answers to judges who missioned the “Expert”. How can linking between a criminal act and a personality traits be done before any trial and sentences are pronounced by the Court? Psychocriminological questions, more and more frequent and gaining weight into the judge's order might be best answered with a procedure reshaping. The creation of a specialized department employing a multidisciplinary staff could be an idea about how to address efficiently such difficult questions to be answered under the current proceeding. Conclusions The author offers a point of view based on his own practice of psychological assessment for the Court and which types of improvement could be proposed in order to follow the changes operating within the criminal justice system. [ABSTRACT FROM AUTHOR]

Résumé Le traumatisme peut venir fragiliser l’organisation somatopsychique du sujet et entraîner la nécessité d’un travail d’élaboration psychique. Cependant, de façon à éviter les affects de déplaisir, les sujets traumatisés utilisent souvent inconsciemment la répression émotionnelle qui se substitue alors à une création de sens à propos de l’événement (symbolisation). De fait, les psychologues peuvent alors observer, parfois plusieurs années après, la réactivation d’affects violents non élaborés lors de la rencontre clinique, au travers de mouvements de projection et d’identification. Or, la rencontre avec le traumatisme peut être aussi effractive pour le psychiste que pour la victime du fait de la complexité des mouvements pulsionnels mobilisés (allant de l’agressivité à l’identification à l’agresseur, sans oublier les mouvements de voyeurisme ou de séduction). Cet article questionne les destins de ces mouvements pulsionnels investis dans l’écoute psychologique de sujets maltraités. Méthodes et patients Nous présentons deux situations cliniques, l’une rencontrée dans le champ de la protection de l’enfance et l’autre dans celui de l’assistance médicale à la procréation (AMP). Résultats L’analyse des mouvements pulsionnels (y compris agressifs) permet aux psychologues d’entendre et de prendre en compte la douleur traumatique, souvent masquée ou déniée lors de la rencontre initiale. La reconnaissance de l’agressivité permettrait d’échapper au risque de la sympathie (introduisant une confusion des langues). Elle permet aussi au clinicien de créer une alliance thérapeutique avec le patient, non basée sur la fascination pour des faits traumatiques mais sur la possibilité de rejouer la détresse, ou la violence, d’éprouver à nouveau la colère ou la frustration dans des conditions émotionnelles sécures, autorisées par la capacité du clinicien à se laisser attaquer sans se faire détruire. Traumatic experiences could weaken the psychosomatic organization of subjects and introduce the necessity of a psychic elaboration. However, to avoid displeasure, traumatized subjects often use unconsciously emotional repression instead of a creation of sense of the event (symbolization). So, psychologists can observe, sometimes several years later, that the violent affects could be reactivated during the meeting with a clinician by the way of projections or identifications. Or, the encounter with trauma could be as much invasive for the psychist as for the victim, due to the complexity of instinctual motions (from aggressiveness to identification with the aggressor, voyeurism temptation or seduction). This paper examines the destiny of these instinctual motions in psychological practice with people abused. Methods and subjects We present and discuss two clinical cases from our psychological practices, one in the field of child's protection, the other in the field of medically assisted procreation (MAP). Results Analysis of the instinctual movements (include the aggressive ones) allows the psychologists to perceive and take into account the traumatic pain, often hidden or denied during the first encounter. The recognition of aggressiveness could permit to get out of the risk of sympathy (introducing a confusion of languages). It also allows the clinician to create a therapeutic alliance with the patient, not based on fascination about trauma but on the updating's possibilities of distress or violence, the re-experienciation of anger or frustration in secure emotional conditions allowed by the non-destructiveness of the clinician. [ABSTRACT FROM AUTHOR]

Résumé Les récents attentats et tentatives d’attentats sur le sol français, liés à la mouvance islamiste, ont amené les auteurs de cet article à se questionner sur ce qui peut pousser une personne à choisir le chemin de la lutte armée dans le cadre de croyances religieuses détournées. Ils se sont appuyés sur une revue internationale de la littérature psychologique et psychiatrique afin de tenter de dégager les processus explicatifs sous-tendant le processus d’adhésion à une idéologie radicale et le basculements d’individus dans le terrorisme. Les auteurs se sont focalisés sur trois axes principaux : une présentation générale du terrorisme et de ses liens éventuels avec la psychiatrie et la psychopathologie ; la figure du « loup solitaire », mais aussi des cellules terroristes organisées responsables d’action mieux coordonnées ; les données pouvant être utilisables sur un plan pratique par les enquêteurs chargés des investigations et des interrogatoires. Ils rappellent pour terminer les grands principes de la prise en charge des terroristes dans les processus de « déradicalisation » par le biais de protocoles visant à réinstituer un sentiment individuel positif d’existence. Au cours de ce travail de recherche, il est apparu que la psychopathologie ne pouvait expliquer les actions les plus préparées et les mieux organisées et que ce n’était que dans la figure du loup solitaire que l’on pouvait souvent trouver des troubles graves de nature psychiatrique. Chez les « recrutés » pour le djihad et chez les auteurs d’actes terroristes, on observe néanmoins une dimension fonctionnelle paranoïaque dans la vision du monde ainsi qu’un état d’insatisfaction existentielle. Ces individus trouvent dans l’idéologie extrémiste proposée une spiritualité qui rassure et donne du sens à leur vie. Objectives This paper intended to offer a broad literature review on global Jihad terrorism. In the wake of recent terrorist attacks that stroke Paris twice in 2015, and the numerous defused plots this year, the authors sought to determine if there is a way to get a better understanding of the radicalization process. How individuals could become radicalized to the point of engaging into violent actions and suicide missions and is there any underlying psychopathology? The authors focused on two types of terrorists: lone wolves and those acting as part of a group. We will explain that psychopathology could not be linked with the “group” type. We will discuss some aspects of the psychological mechanisms involved into the group dynamics that bond individuals towards this (self-) destructive goal, but also how law enforcement officers should be prepared to counter-interrogation techniques spread amongst members of organized cells. Finally, we will see how a deradicalization process might take place. Methods The authors relied on a broad literature review in order to address the issues mentioned above. Mainly for two reasons, the first one being that most of suicide mission leaves no author to interview or to assess; second, access to highly sensitive cases of terrorism is not possible unless being involved within the judicial process such as psychological or psychiatric assessments of survivors or members of a dismantled cell, but data then could not be used for publication, these are the reasons why the authors used open source data and international articles and books dealing with the topic of global Jihad. Results As noticed by Hoffman, the term « terrorism » comes from the French “(Régime de) Terreur” and implies a political goal, the Oxford English Dictionary defines it as “A policy intended to strike with terror those against whom it is adopted; employment of methods of intimidation; the fact of terrorizing or condition of being terrorized”. From the mid-1990s during which France was already hit by terrorism, through the 9/11 to the recent attacks of November, the aspect of the “global Jihad” evolved and the attacks that took place in Paris and also worldwide in 2015, claimed by Daech bring some points to be taken into consideration when dealing with this type of terrorism. First, the will to die and to gain martyrdom, which is not considered as a suicide, is central for an understanding of this morbid process. Most of the terrorists seem to be looking for a greater-than-themselves cause that they could embrace, and the ideology offered by Daech correspond to an “epic” vision of the world. This view serves as an encompassing model in which the reality is perceived through a “us versus them” prism that possesses a paranoid tone. Second, some strategic considerations, which will not be developed here, why France has been more specifically targeted? The development of “homegrown” terrorists, as Sageman noted it in 2006 and the rise of ISIL (Daech) from 2010 and the instauration of a Caliphat as a base and training ground offered to the new recruits had created a fertile soil for jihad motivated attacks. Through this extensive literature review the authors found that, contrary to the “lone wolf” figure in which psychopathology and psychiatric symptoms could often easily be found, members of organized terrorist cells are not “insane”, they are very much dedicated to a cause but are not suffering from any psychosis or bipolar disorders. Exploring the ideas developed by Sageman, Moghaddam amongst others, the authors underline the slow process for developing and sharing radical beliefs but also that taking part to violent actions could be faster than imagined by a layman and is regularly a matter of networking through friendship and kinship. Thus, group psychology is of peculiar importance to understand the mechanisms at stake. It appears that radicalization is grounded on a vacuum of existential significance and by an ascending process, through the sharing of an ideology prone to violent actions, leads individuals to engage in terrorist goals for a collective one, greater than them. The authors then focused on some interrogatory techniques developed by foreign law enforcement agencies. And finally, what could be done to reverse this radicalization process, basically reintegrating a sense of individualistic needs and addressing the radical beliefs with a religious teaching. It should be noted that this last part is at the very beginning of its experimentation in Europe and that it might not be used for every individual involved in terrorism (e.g., it could be proven efficient with people that has been radicalized, but not efficient with individual on the brink of violent terrorist actions). The central need to counter radicalization is a social one, a project of society shared by everyone, as it seems clear that the sense of alienation and exclusion from the working environment and positive social perspectives is a strong leverage, but not the only one, used by jihadist recruiters. [ABSTRACT FROM AUTHOR]

Résumé Introduction Le terrorisme suicide est la forme la plus meurtrière de terrorisme. C’est la seule forme de combat où l’attaquant envisage des actions extrêmes dans lesquelles il ne prévoit pas de survivre à la mission. Le mode opératoire adopté est difficilement explicable, car l’attaquant décide avec détermination de se suicider en même temps qu’il décide de tuer. Objectif et méthodes Notre travail propose une revue de la littérature théorique existante afin d’examiner le profil psychopathologique du terroriste suicidaire. Résultats Peu d’études formelles ont été publiées sur la psychopathologie des terroristes suicidaires, avec des résultats mitigés. Différentes études sur le sujet ont conclu qu’il n’existe aucun attribut psychologique particulier pouvant décrire une « personnalité terroriste ». D’après certains auteurs, les terroristes suicidaires sont dotés d’une santé mentale solide et n’ont pas de passé criminel. En effet, les recruteurs de futures bombes humaines écarteraient d’emblée les personnes d’allure mentalement instables. Cependant, cela a été contredit par d’autres études montrant qu’un grand nombre de kamikazes que la police avait arrêtés après échecs de leurs attentats suicides étaient mentalement déséquilibrés ou cognitivement déficients. Plusieurs études ont affirmé que les terroristes suicidaires ne sont pas en réalité suicidaires. Mais il n’y a aucune preuve, étant donné l’absence d’utilisation d’outils d’évaluation structurés et systématiques. Conclusion La genèse du terroriste suicidaire semble être multifactorielle. L’étude du profil psychopathologique des terroristes suicidaires devrait avoir des implications cliniques et préventives. Background Suicide terrorism is a deadly practice which appears to be rising across the globe. Interest in understanding its motivations and its psychological underpinnings has increased in recent years. In fact, the recent increase in suicide terrorism posed new challenges to mental health professionals who need to better understand this terrifying phenomenon, to implement intervention strategies that are effective. Our purpose was to explain why particular individuals become willing to die as suicide bombers. Materials and methods This paper reviews the worldwide literature on motivations and psychology of suicide terrorism. Results It is difficult to identify an understanding of what motivates a suicide bomber. Researchers have argued that most suicide bombers are psychologically normal and are deeply integrated into social networks. Participation in suicide bombing seems to be motivated by a wide range of factors. Contrary to the common assumption that suicide terrorism is committed by religious fanatics, suicide bombers are politically-motivated individuals. Several authors claim that suicide terrorism has a range of characteristics which are shown to be very different from ordinary suicidal behavior. Suicidal symptoms and suicidal intent are completely absent in suicide terrorists. A number of authors claim that the causes of suicide bombings lie not in individual psychopathology but in broader social conditions. Conclusions Psychiatry has a valuable role in understanding the group and individual processes which contribute to terrorist attacks. Methods developed by suicidologists, such as the psychological autopsy technique, could be an important tool in the study of suicide terrorists, and may ultimately contribute to the prevention of future attacks. [ABSTRACT FROM AUTHOR]

Résumé En nous basant sur les facteurs communs du traitement psychothérapique des troubles post-traumatiques évoqués dans le premier article de ce dossier, nous nous proposons de développer les principes de la prise en charge psychothérapique des sujets psychotraumatisés. Notre exposé ne fera donc ici nullement référence aux Écoles théoriques (comportementales, cognitives, psychanalytiques et autres…) mais s’intéressera aux déterminants thérapeutiques destinés à apaiser les troubles psychiques post-traumatiques lors des phases immédiates ( defusing ), post-immédiates ( débriefing ), et différées. Basing ourselves on the common factors of psychotherapeutic treatment of post-traumatic stress disorder mentioned in the first article of this folder, we intend to develop the principles of the treatment. Our paper will therefore have no reference to theoretical schools (behavioral, cognitive, psychoanalytic and others…) but will look at therapeutic determinants to appease the psychic post-traumatic disorders with defusing, debriefing and psychotherapy. [ABSTRACT FROM AUTHOR]

Résumé L’épilepsie entretient des liens historiques avec la psychiatrie que l’essor des médicaments antiépileptiques est venu réanimer. Les principales hypothèses concernant les mécanismes d’action des médicaments antiépileptiques sur les canaux ioniques (sodiques, potassiques et calciques) et sur la neurotransmission de voies glutamatergique et GABAergique sont présentées. Les auteurs présentent ensuite les propriétés thérapeutiques possibles et les effets indésirables potentiels de ces molécules sur les symptômes et les pathologies psychiatriques. À titre d’exemple, ils rappellent les indications du valproate, de la lamotrigine et de la carbamazépine dans le traitement des troubles bipolaires et évoquent l’intérêt possible de certains autres médicaments antiépileptiques dans cette maladie. Epilepsy has been linked to psychiatry for more than a century and a half. Over the past few decades, serendipitous discoveries have shown the efficacy of some antiepileptic drugs with certain mental disorders. As such, a new age seems to be born in neuropsychiatry. In this paper, the authors summarize the main hypotheses regarding the mechanisms of action of antiepileptic drugs on neurotransmission (glutamate and GABA pathways), and on neuronal ionic channels (Sodium, Potassium, Calcium, Chlorine). Moreover, the main positive effects on mood, sleep, anxiety, addictions observed under these drugs are listed. On the other hand, the potential psychiatric side effects (depression, stress, psychotic disorders, impulsivity) induced by antiepileptic drugs are also reviewed. Finally, the authors comment on the use of antiepileptic drugs in the curative and the maintenance treatment of bipolar disorders. [ABSTRACT FROM AUTHOR]

Tolstoy's landmark novel, Anna Karenina, showcases human passion and desperation at its penultimate, where the main character is carried away by passionate love to the point where she succumbs to overbearing psychological pain. This remarkable novel paints a sophisticated landscape of emotions, feelings and desires in Anna Karenina's dynamic "inner world", thus demonstrating Tolstoy's masterful insights into the human psyche. As such, there is an intriguing opportunity to provide a modern day psychiatric diagnosis to Tolstoy's key work and lead character. Nevertheless, much care should be taken in applying such a current psychiatric diagnosis, which may unfortunately place Anna in certain pre-established categories, without properly considering the author's time context and literary genius. In this light, Tolstoy wrote Anna Karenina well before psychiatry became a modern medical science, with its current framework of understanding for various mental illnesses. His portrait of Anna's psyche is all the more remarkable, as it richly displays the inner workings of Anna's psyche: Her emotional experiences, her feelings, her dreams? all perfectly illustrating a so-called Tolstoian psychology. Thus, this paper provides several current psychiatric insights to Anna's character, to her destiny, and the "denouement" of the storyline. And even more interestingly, it explores the story and its characters by keeping in mind Tolstoy's own personality structure, beliefs, needs, and desires. Similar to a Freudian interpretation of dreams, the novel's characters could, in certain respects, be understood as representing different aspects of the author himself. One hypothesis is that Anna Karenina could be considered Tolstoy's "literary testament", in that the figure of Anna is the expression of the powerful emotional momentum behind its author. [ABSTRACT FROM AUTHOR]

Résumé Onze communications sur des interventions médico-psychologiques lors de catastrophes naturelles ou de guerre ont illustré les divers volets de la psychiatrie de catastrophe : classification et critères des catastrophes, différentes catégories de victimes et d’impliqués, tableaux cliniques et comportements collectifs observés, traitement aux phases immédiate, post-immédiate et différée-chronique, prévention. Eleven papers on medico-psychological interventions in natural or war disasters have illustrated the diverse parts of the disaster psychiatry: classification and criteria of disasters, different categories of victims and implicated persons, clinical features and collective behaviors observed, treatment in the immediate, post-immediate and delayed-chronic periods, and preventive measures. [ABSTRACT FROM AUTHOR]

Résumé Le 24 juillet 2014 s’écrasait l’avion du vol AH5017 de la compagnie Air Algérie dans le Sud du Mali, avec à son bord 116 passagers dont 54 Français. L’événement a pris une dimension nationale en raison de l’ampleur de la catastrophe, en exigeant une réponse rapide des autorités françaises, à laquelle s’est associée une mobilisation internationale. Il a présidé à l’engagement des forces françaises, prépositionnées au Mali, pour répondre au plus tôt à la gestion de cette catastrophe. Les personnels du Service de santé des armées, lesquels assurent le soutien médical des forces en opérations, ont été mis à contribution, en particulier dans leur mission de soutien médico-psychologique, avec le renfort des équipes médicales sur le terrain par un psychiatre des hôpitaux des armées. L’intervention médico-psychologique réalisée à l’occasion de cet événement est ici détaillée. Introduction On the 24th July of 2014, the plane of the Air Algeria airline flight AH 5017 crashed in southern Mali with 116 passengers on board, including 54 French. The event required a prompt response of the French authorities, associated with an international mobilization. It presided at the commitment of the French military forces, which were prepositioned in Mali, in order to manage as soon as possible this disaster. Personal of French military health service, which provide medical support to forces in operations, were involved, with the reinforcement of the medical teams on the spot through a psychiatrist of military hospitals. Method This work is based on the methodology of an experience feedback, by emphasizing the most salient points of the medico-psychological intervention realized on the occasion of this event. Results The mission assigned to the French military forces was scalable: research for potential survivors, by providing them with the necessary help and care; identification of victims, by collecting the maximum of clues that could facilitate their recognition (identity papers, personal effects…); first judiciary and forensic findings; securing the crash zone to prevent outside intrusion on the scene. It ended with an unusual task involving the collection of human remains on the crash zone. Various experts were also essential for carrying out several surveys: an aeronautic investigation about flight safety, a criminal investigation to find the causes of an event which involved human deaths, and a forensic investigation working to identify the victims. The medico-psychological support included several prospects. The presence of a psychiatrist on the crash zone firstly allowed a psychological support for the staff early involved, and exposed to a startling scene; it anarchically combined debris of a pulverized aircraft cabin, personal passengers effects mixed with carbonized human remains in a disgusting unbreathable atmosphere. In a second time, it offered a presence for many units and personal engaged in an unexpected and testing mission. Facing an unusual situation, the main authorities involved on the area were accompanied by offering mental health advice in response to the everyday life events of a makeshift camp in the middle of the African desert. The psychiatrist's action consisted in a work of mediation within the group by helping the flow of speech. The psychiatrist is also the privileged contact of the subject, by offering both a differentiated space, separated from the rest of the military environment, and a singular listening, allowing the welcome of a possible mental pain. The mission of collecting human remains required a special attention because of its psycho-traumatic risk. A volunteering principle was applied, as well as the identification of fragile or vulnerable subjects among volunteers, which concerned a total of a hundred soldiers. All the personal involved in this task were identified by the commandment, and then secondarily received in collective debriefing. Conclusion The presence of a specialist of psychological care within a disaster shows an availability, which can lead to the possibility of a welcome, with a potentiality which already appears as a form of response and acknowledgment of a possible psychological suffering. Thus, the challenge consists in providing an assistance, which is less a gauche interventionism or an artificial forcing of an inaccurate request for care, than a careful and concerned presence for the psychological health of everyone. [ABSTRACT FROM AUTHOR]

Résumé Dans une précédente communication (Luauté, 2014), nous avons montré qu’une conception dominante en France soutenait l’existence d’un lien direct entre conditions actuelles de travail et suicide au travail. Outre le choix du lieu, des mises en accusations précises de la part des suicidés tendent à confirmer la signification protestataire de ces actes. Ceux-ci sont à rapprocher des modèles de « suicide vengeance » et de « suicide sacrifice » issus d’une tradition extrême-orientale de la mort volontaire. L’absence de tout facteur de psychopathologie individuelle est chaque fois subsumée. Récupéré comme un mode majeur d’expression politique, le suicide au travail mérite aussi d’être questionné comme une forme insidieuse de terrorisme. En tant que phénomènes spectaculaires, les suicides au travail et le terrorisme actuel ne se conçoivent pas sans le rôle des médias. In a previous paper (Luauté, 2014), we have shown that a prevailing view in France advocates the existence of a direct link between the current conditions of work and work-related suicide. In addition to the choice of the whereabouts, specific accusations by those who commit suicide, tend sometimes to confirm the protesting signification of their action. Therefore, they can be regarded as modes of revenge and sacrifice closely patterned on far-eastern traditions of voluntary death. In each time, the lack of an individual psychopathological factor is subsumed. Having recourse to suicide is now viewed as a major mode of political expression which deserves to be considered as an insidious form of terrorism. At-work suicides as spectacular phenomena, as well as present days’ acts of terrorism, are inconceivable without the role of mass media in our societies. [ABSTRACT FROM AUTHOR]

Résumé Cette communication concerne les apports de la recherche en psychologie légale sur les intimes convictions du clinicien. Elle fournit des rappels et propose des repères en vue d’étayer, voire d’interroger les convictions. Elle repositionne les distinctions épistémologiques entre la psychologie et le droit. Elle rappelle que les émotions et les processus de pensée sont interdépendants, notamment du point de vue des neurosciences. Elle aborde des concepts de recherche peu abordés par les praticiens cliniciens : la différence entre les erreurs de type I et II, la prévalence de faux-positifs parmi les pronostics. Elle souligne l’importance des biais de communication concernant l’appréciation du risque de dangerosité. Elle rappelle l’importance des idées reçues. Elle conclut sur l’importance de nourrir la pratique clinique et judiciaire par la recherche continue en psychologie légale. The paper addresses the interest of research in forensic psychology. First, we recall four epistemological differences between scientific psychology and the law. We address decision processes which incorporate as major co-determinants, cognitions but also emotions. We describe key research notions, few covered by experts, like type I and II errors, false predictions, confidence intervals. We describe common beliefs among clinicians that are disconfirmed by empirical research. We also address the communication of risk formats and their influences on decision processes. We encourage the dissemination of forensic research among practitioners. [ABSTRACT FROM AUTHOR]

Résumé La thérapie interpersonnelle est une thérapie brève, limitée dans le temps, développée à la fin des années 1970 et présentée dans un manuel en 1984 par G. Klerman. Elle a fait l’objet de nombreuses validations et elle se trouve dans les recommandations internationales en tant que traitement actif de la dépression. Pourtant, elle reste peu connue. L’une des raisons de cette diffusion limitée pourrait être en lien avec ce manuel qui semble surtout adapté à la recherche. De même, la théorie de l’attachement, qui représente la base conceptuelle de référence pour la thérapie interpersonnelle, n’est pas abordée au niveau du processus thérapeutique. Or, plusieurs études ont démontré que les styles d’attachement sécures expliquent en grande partie la qualité des relations interpersonnelles et le bien-être psychologique que les individus en retirent. En outre, l’attachement est de plus en plus présent dans des approches différentes, aussi bien longues que brèves, dans la mesure où il ouvre des perspectives thérapeutiques très prometteuses. L’objectif de cet article consiste à expliquer en quoi l’intégration du concept bowlbien à la thérapie interpersonnelle classique apporte un éclairage permettant de mieux appréhender les décompensations dépressives en lien avec les dysfonctions interpersonnelles. Dans cette optique, nous proposons de présenter notre modèle basé sur l’attachement comportant une articulation psychopathologique et clinique ainsi qu’une régulation émotionnelle interpersonnelle comme levier thérapeutique. Interpersonal therapy is a time-limited brief therapy, developed in the late 1970s and manualized in 1984 by G. Klerman and his collaborators. Although recognized as one of the theoretical foundations of interpersonal therapy, attachment theory has been under-exploited in practice. The aim of this paper is to present our model based on attachment theory with a psychopathological, clinical and therapeutic integration in line with the needs of a brief approach. Our model relies on the hypothesis that an insecure attachment style is a risk factor for psychiatric disorders. Indeed, Bowlby's model enables for a better understanding of these relationships and proposes a therapeutic approach based on the patient's attachment needs. In practice, the therapy is structured over a period of 12 to 16 weekly sessions. Our contribution to classical interpersonal therapy, during the initial phase, is the evaluation of the patient's attachment style by reviewing the early experiences of attachment, interpersonal and romantic attachment. In parallel, we review all the depressive symptoms and explore life events surrounding their onset in order to identify the interpersonal problem area on which will focus the therapy: Grief, interpersonal disputes, and role transition. In our approach, interpersonal disputes are explored through emotionally charged incidents in connection with avoidance and anxiety dimensions assessed with the Experience in Close Relationships Scale. During the intermediate phase, therapeutic work is to solve the patient's interpersonal problem by helping him to re-evaluate his expectations in terms of attachment through a number of techniques. These are focused on a therapeutic relationship as a secure base, interpersonal emotional regulation and interactional regulation. The final phase closes the therapy and helps the patient to review his progress and to plan the future. It is important to prepare the end of the therapy with the patient, as it can be experienced as abandonment, especially for those with an anxious attachment style. [ABSTRACT FROM AUTHOR]

Résumé La visite des parents à leur enfant placé est le principal mécanisme par lequel il est possible de maintenir la relation parent/enfant lorsque les familles sont séparées par le placement. Si la réflexion sur le sujet est riche au plan clinique, les recherches sur ce thème demeurent encore rares. Cet article présente une revue de la littérature autour des enjeux de la visite parentale dans le cadre du placement de l’enfant en institution. Nous discuterons des bénéfices démontrés pour le bien-être de l’enfant et le devenir du placement, mais aussi les questions que soulèvent certains effets négatifs. Enfin, de nouvelles pistes de recherches et de réflexions dans ce domaine seront proposées et étayées par la présentation rapide des résultats d’une recherche exploratoire pilote récente sur l’effet de la visite parentale chez le bébé placé. Background One of the major challenges in child protection is about building or maintaining the relationship between the child and her/his biological parents. It is usually the children's judge, aiming at preserving the child's interests that requires the placement, while fewer placements occur on a voluntary basis. Parental visitation is the main mechanism liable to maintain family ties during placement and to help the child dealing with the feeling of abandonment. The literature on this subject is historically anchored in the field on the effect of maternal deprivation that was so important after the Second World War. However, although profuse, available literature is still essentially composed by clinical writings made by clinical professionals who share their experiences and questions derived from their every day practices. Relatively to its meaning and value to child protection policies and practices, there are only a limited number of scientific reports and empirical studies including assessment protocols on the effect of maintaining the contact between the child placed for protection purposes and her/his parents. Aims The present paper proposes a literature review on the issues at stake around parental visitation of children placed in institutional context. Results The authors review the main results of the literature on the beneficial effect of parental visits to the placed child, notably in terms of child well-being and placement outcome and duration. It also emerges that research in this field still suffers of quite passionate but quite old controversies of two kinds: firstly, the suitability of organizing parental visitation on a systematic basis; secondly, how to understand and interpret the negative reaction that some children show after having contact with their biological parents. The authors also discuss the methodological issues and weaknesses regarding sample selection, variable control, and scientific validity of assessment methods. Perspectives The authors propose a change of standpoint that opens the discussion to new directions for future research, aiming at emerge from entangled positions pro or against the maintaining of the parent-child relationship in case of placement. These new perspectives are detailed and illustrated by the presentation of the results of a recent exploratory research on the effect of parental visitation for babies placed in foster institutional care. Undoubtedly, more research is needed in the field of child protection, and in particular, on the issue of maintaining the contact between the child and his/her family, and its modalities, in order to provide a constructive support to the child and his/her family and a more grounded basis for the decision making process. [ABSTRACT FROM AUTHOR]

Résumé Les dispositions françaises de l’obligation de soin sont présentées au travers de l’exposé du travail psychothérapique mené dans le cadre d’entretiens réguliers d’un « agresseur sexuel » auprès d’un thérapeute. Les conditions du passage à l’acte de nature sexuelle d’un père sur sa fille seront abordées à partir d’une manifestation hallucinatoire. La situation d’inceste agi permet aux auteurs de revisiter la question de l’inceste dans sa version du passage à l’acte au regard d’une clinique orientée par la référence à la psychanalyse. Le dispositif orienté par l’obligation de soin pris dans la conception d’une « enveloppe psychique » a pu permettre la relance de la position subjective du patient. The point of compulsory care and its effects are presented here through the description of psychotherapeutic work undertaken in the form of regular discussions, lead by a therapist, with a “sexual attacker” who committed acts of incest on his daughter. The authors provide a wide-angle analysis of therapeutic attitudes (in and out of prison) related to sexual behaviour: legal and ethical questions raised and the cornerstone of the psychopathology of such disorders is criticized. It allows the authors to revisit the situations of incest with regard to the clinic care oriented toward psychoanalysis. We must move towards the through-making process itself the place of de-subjectivation. This means that the therapist's role is fundamental in a relationship from subject to subject. This paper presents the various devices utilized for the compulsory care. The recounting of the occurrence of incest shows a method of committing the act, which is borderline to psychosis. The analysis of resorting to sexual acts has more to do with a theorical mapping of the perverse act (for a psychopathological clinic of the transgressive act); the underlying personality structures, being varied, can be revealed by the positioning of the subject faced with his act in the after-event. The plan implemented through compulsory care allowed the re-evaluation of the subjective position of the person on trial. [ABSTRACT FROM AUTHOR]

Résumé Dans cette communication, l’auteur évoque certains aspects des états de stress traumatiques. Il cite ses propres travaux dans des cadres institutionnels divers et dans sa pratique, en centrant son propos sur l’intérêt de l’action de certains bêta-bloquants (le propranolol) sur les mécanismes des mémoires traumatiques. In this paper, the author discusses some aspects of traumatic stress states. He cites his own work in various institutional settings and in his practice, focusing on the interest of the action of certain beta-blockers (propranolol) on the mechanisms of traumatic memories. [ABSTRACT FROM AUTHOR]

Résumé L’apprentissage de la psychiatrie pour l’étudiant en médecine est l’occasion d’appréhender le patient en tant qu’individu réagissant à sa maladie en fonction de son histoire personnelle, ses antécédents, ses traits de personnalité et son contexte socio-culturel. Pourtant les notions de psychopathologie qui pourront lui être transmises lui paraissent bien souvent inaccessibles et inutilisables. La psychologie de la santé permettrait au contraire de fournir à l’étudiant en médecine un socle de connaissances psychologiques facilement transférables dans le reste du champ médical. Cet article propose une base de connaissances minimales en psychologie de la santé. Les représentations de la maladie, déterminantes majeures de la mise en place de stratégies d’ajustement à la maladie et de comportements de santé, seront présentées dans une première partie, pour ensuite détailler dans une deuxième partie les mécanismes de mise en place de ces stratégies et comportements. Une fiche synthétique regroupant l’ensemble des concepts développés sera proposée. When a medical student is learning psychiatric, he has the opportunity to understand the patient as an individual that reacts to his illness according to his personal history, backgrounds, personality traits and socio-cultural context. Yet, the concepts of psychopathology that can be transmitted to him seem often unreachable and unusable to him. Health psychology would instead provide the medical student with an easily psychological knowledge base transferable in the rest of the medical field. This paper proposes a minimal knowledge of health psychology. In the first part, the representations of the disease, the major determinants of the development of health behaviors and coping strategies to illness, will be presented. In the second part, the mechanisms of implementation of these strategies and behaviors will be presented. A synthetic support card containing all the proposed concepts will be proposed. [ABSTRACT FROM AUTHOR]

Résumé La psychoéducation occupe aujourd’hui une place essentielle dans le champ des approches psychosociales. Initialement proposée aux patients psychotiques chroniques, elle s’est peu à peu étendue à d’autres types de pathologies chroniques, tels que les troubles bipolaires. Dès les années 1970, des cliniciens spécialisés dans les démarches thérapeutiques comportementales et cognitives enrichissent les programmes de psychoéducation avec des composantes propres aux thérapies comportementales et cognitives (TCC) pour devenir des programmes de réhabilitation du psychotique chronique. Il faudra attendre les années 1990 pour voir apparaître la même combinaison d’intervention psychoéducation plus TCC pour des patients souffrant d’addictions, de troubles de l’humeur récurrents tels que les troubles bipolaires. Depuis 1996, au moins cinq programmes psychoéducatifs TCC ont été développés pour ces patients. Parmi eux, le programme de Lam et al. (1999) constitue la référence internationale, de par le nombre important de publications concernant son efficacité. Nous présentons ici, d’une part, la démarche psychoéducative TCC dans sa mise en place historique, en insistant sur les différences de pratiques qu’il existe entre psychoéducation, approche TCC et éducation thérapeutique du patient qui voit aujourd’hui son développement se généraliser. Nous décrirons notre expérience depuis dix ans au centre de psychothérapie universitaire CMME, du Centre Hospitalier Sainte-Anne de Paris. Nous décrirons les résultats cliniques et psychologiques d’un programme de psychoéducation TCC pour patients bipolaires I partiellement améliorés par leurs traitements pharmacologiques cependant bien conduits (patients réfractaires). Les résultats principaux constatés chez 139 sujets sont une amélioration du fonctionnement psychologique associé à la dépression (c.-à-d., croyances dysfonctionnelles, estime de soi) et de la qualité de vie (c.-à-d., relations sociales, santé psychologique) pour des patients bipolaires qui ont connu en moyenne plus de 13 épisodes thymiques et qui, malgré les traitements pharmacologiques thymorégulateurs, connaissent encore des récurrences aux fortes répercussions psychosociales. In recent years, psychoeducation is largely used in the field of psychosocial approaches. Originally proposed for chronic psychotic patients it is gradually extended to other types of chronic diseases such as bipolar disorder. Since the 1970s, Cognitive Behavioral Therapy (CBT) is associated with psychoeducation to become rehabilitation programs for chronic psychotic patients. In the 1990s appears the combination CBT + psychoeducation intervention for patients with substance abused, mood disorders in particular bipolar disorder. Since 1996, five psychoeducational CBT programs have been developed to patients with bipolar disorder. Among them, the Lam et al. program is the international reference, from the large number of publications concerning its effectiveness. We present here the psychoeducational + CBT in theses different aspects: historical developments, definition of terms, differences with other approaches as educational training developed recently in medical setting. We describe in this paper the program proposed by Lam et al. (1999), as conducted in our academic department of psychotherapies in Sainte-Anne's hospital in Paris with 139 refractory bipolar I outpatients. The main results show an improvement in psychological functioning associated with depression (i.e., dysfunctional beliefs, self-esteem) and quality of life (i.e., social relationships, psychological health) for bipolar patients significantly weakened by the duration of illness, the number of recurrence (average of 13 thymic episodes) and the burden psychosocial consequences. [ABSTRACT FROM AUTHOR]

Résumé Objectif À la frontière de l’histoire de la littérature et de l’histoire de la psychiatrie, cet article étudie la genèse de ce que l’on pourrait appeler les excursions asilaires que pratiqueront plus tard les chercheurs d’art et de lettres , comme Jean Dubuffet, à travers asiles et hôpitaux psychiatriques. La présente étude cherche à déterminer ce qui a pu toucher ces voyageurs, en premier lieu en découvrant les productions des aliénés, et ce qu’ils ont pu en tirer. Méthode Le corpus s’appuie, pour ce faire, sur deux récits qui relatent les voyages de Maurice Palluy en 1832 au cœur de l’asile de Charenton, dont il a la direction depuis peu, et d’Émile Daurand Forgues, homme de lettres et de journaux, qui relate son périple à l’asile de Bicêtre en 1840. Suivant le corpus donné, l’article est divisé en deux parties distinctes, consacrées à chacun des deux voyages. Résultats Parmi les aliénés qu’ils rencontrent, Palluy et Forgues découvrent des « écrivains ». Frappés par la forme et la manière dont certains formulent leurs idées, ils en viennent à dresser des diagnostics, parmi lesquels celui de la monomanie , et à considérer comment la folie prend forme dans des textes. Conclusion L’analyse des textes de Palluy et Forgues pose la question suivante, sur laquelle la conclusion du texte s’étend : les textes que rencontrent nos intrépides voyageurs relèvent-ils de l’ordre de la folie ? Le cas échéant, comment ? La réponse n’est pas simple et invite encore à se poser la question : qu’est-ce que la folie ? Objective Where history of literature and history of psychiatry meet, this article studies the genesis of what we could call the asylums excursions that art and letters prospectors , as Jean Dubuffet, will undertake later through asylums and psychiatric hospitals. The study aims to determine what could have affected them by discovering the productions of insane and what they could have got. Method To do so, the corpus is based on two stories related to the travels of Maurice Palluy in 1832 at the heart of the asylum of Charenton, which he has been running since short, and of Émile Daurand Forgues, man of letters and newspapers, who relates his trip at the asylum of Bicêtre in 1840. As determined by the corpus, the paper is divided into two separate parts, dedicated to each of the travels. Results Among the people interned, Pallu and Forgues find « writers ». Impressed by the form and the way in which some articulate ideas, they come to provide diagnostics, which include monomania , and to consider how madness is taking shape in texts. Conclusion The analysis of the texts of Palluy and Forgues ask that question: are the texts that they find mad? If so, how? There is no easy answer and the classical question arises again: what is madness? [ABSTRACT FROM AUTHOR]

Résumé L’étude des écrits médicaux anciens offre, au même titre que les études transculturelles, la possibilité aux psychiatres de reconnaître aux troubles mentaux des expressions constantes ou au contraire variables qui orientent vers une pathogenèse de nature plutôt biologique ou plutôt socio-culturelle. Cet article examine la question délicate du diagnostic rétrospectif et de la catégorisation pathologique des troubles mentaux dans les écrits médicaux anciens, et tente d’y répondre d’une manière pragmatique et opérationnelle. Une méthodologie spécifique, psychiatrique et historique, a été mise au point et appliquée à un corpus de plus de 2000 consultations écrites françaises des xvi e siècle et xviii e siècle. Les résultats de cette application sont illustrés par l’analyse détaillée d’une dizaine de cas et discutés dans leurs implications pour la recherche psychiatrique historique. Objectives Like cross-cultural studies, research on ancient medical writings allows psychiatrists to identify constant and variable expressions of mental disorders; this may in turn allow discrimination between pathogenesis mainly of a biological nature and that mainly of a socio-cultural nature. However, the study of these writings presents many problems which require the development of specific and rigorous research methodologies. In particular, close attention is needed for the identification and characterization of mental disorders, a process which is usually referred to as “retrospective diagnosis”. This paper tackles the difficult problem of retrospective diagnosis and pathological categorization of mental disorders described in historical medical writings and proposes a pragmatic and operational approach to these issues. Patients and methods We propose going beyond the simplistic contraposition of essentialist and constructivist approaches to mental disorders. First, history research questions involving individual diagnosis, either to ascertain whether a given disease or nosological entity is present in a given historical population (situations A1) or to understand a behavior of an individual or group in a given historical context (situations A2), should be distinguished from questions in which the health of a population or a subgroup is of interest (situations B). Situations of type (A1) require the use of all medical knowledge to make a tentative retrospective diagnosis; situations of type (A2) require considering retrolective diagnoses which could have been made at the time the disorder was managed/reported; and situations of type (B) require using robust pathological categorizations and classifications like those used in contemporary epidemiology to allow comparisons between populations. This conceptual and methodological framework was applied to the study a corpus of more than 2000 reports of consultations of French physicians, written during 16th–18th centuries. Retrospective diagnosis was attempted by a group of psychiatrists and historians on the basis of DSM-IV-TR diagnostic criteria for common mental disorders. Results Mental disorders accounted for nearly 4% of the medical conditions dealt with in the consultations; there was no trend for change during the study period. Minor mental disorders, such as depressive, anxiety and somatoform disorders were the most frequent. Serious conditions, characterized by symptoms corresponding to the contemporary categories of bipolar disorder, major depressive disorder and schizophrenia, were also suggested. Conclusions This study evidences the presence, in the early modern French population, of many mental disorders fitting into the categories of contemporary psychiatric nosology. It also demonstrates the feasibility of pathological categorization, and in some cases retrospective diagnosis, of mental disorders described in historical medical writings. These findings have implications for historical research in psychiatry. [ABSTRACT FROM AUTHOR]