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Dans les Aventures de Tintin , Hergé n'a pas manqué de tisser psychologie et psychiatrie dans la trame de fond de son récit. Étant donné la richesse de ses planches en matière de santé et de maladie mentales, nous proposons une revue systématique des albums ainsi que de la littérature médicale aboutissant à une lecture de la sémiologie et de la phénoménologie psychiatriques dans l'œuvre d'Hergé. Les thèmes les plus récurrents sont les délires et les psychoses, les troubles de la personnalité ainsi que les troubles liés à l'usage de l'alcool et d'autres substances psychoactives. Par la suite, nous avons procédé à une analyse de l'évolution de la représentation des asiles et des hôpitaux psychiatriques, des psychiatres et du « fou » au fil des albums. Finalement, nous nous sommes attardés sur l'analyse psychanalytique des « Aventures de Tintin », entreprise par Serge Tisseron, à la recherche d'un secret familial qu'il eut l'impression de déceler en parcourant l'œuvre d'Hergé. Hergé's "Adventures of Tintin" is a renowned Belgian comic book series. The twenty-four albums are rich in psychological and psychiatric elements, intricately woven into a smartly written and complex storyline. These elements have, however, seldom been studied systematically from a psychiatric point of view. In the current paper, we propose a systematic review of the series and of the medical literature concerning the psychiatric semiology and phenomenology found in the work of Hergé. The search terms used in the Pubmed database were "Tintin", "medicine", "medical", "health", "mental", and "psychiatry". Upon reading the integrality of the twenty-four albums, the most recurrent themes found were delusions and psychosis, personality disorders, and alcohol and other psychoactive substance use disorders. We then conduct a chronological analysis of the evolution of the representations of asylums and psychiatric hospitals, psychiatrists and the "mad man" throughout the albums. Finally, we present the psychoanalysis of the "Adventures of Tintin", as developed by the psychiatrist and psychoanalyst Serge Tisseron, who, upon reading Hergé's work, suspected the existence of a family secret that the author might have concealed in his albums. [ABSTRACT FROM AUTHOR]

Cocaine use has tended to increase over the past decade, particularly among younger populations. Cocaine is the second most commonly used illicit substance in France. Over the past few years, there has been an uptick in cocaine consumption in the country. The observed increase in consumption raises questions about the underlying motives. The goal of the present study is to construct and validate a questionnaire that explores the motivation behind cocaine use. This paper consists of two studies conducted on different data collections. In the first study, one thousand, one hundred and thirteen (n = 1113) individuals participated and six hundred and seventy (n = 670) individuals participated in the second study. All participants were current or former cocaine users. These participants completed an online sociodemographic questionnaire, a constructed questionnaire exploring motivations for cocaine use. This questionnaire was developed using the self-determination theory of (Deci & Ryan, 1985) and 11 semi-structured interviews with users. The purpose of these interviews was to explore the motivation for cocaine use, the expected benefits, and the negative consequences. From literature and the corpus of previously completed interviews, a first version of the questionnaire with 31 items was produced. The research respects the ethical recommendations of Helsinki and has received a favorable opinion from the research ethics committee. The data was collected anonymously and on a voluntary basis. In the first study, 574 (51.6%) men and 539 (48.4%) women participated. The mean age of the participants was 25.0 years (SD = 5.83) ranging from 18 to 65 years old. In the second study 310 (46.3%) men and 360 (53.7%) women participated. The mean age of the participants was 25.7 years (SD = 4.23) ranging from 18 to 48 years old. Initially, an exploratory factor analysis was carried out. This first analysis resulted in a 23-item questionnaire with a four-factor solution: pleasant sensations, social pressure and self-image, absence of motivation, and curiosity and experience. The psychometric indicators were quite satisfactory with X2 (465) = 15951, P < 0.001 for the Bartlett test and 0.91 for the KMO (Kaiser-Meyer-Olkin) test. In the second part of the research, the confirmatory factor analysis indicated a solution with three factors and 21 items. Psychometric indicators showed CFI (Comparative Fit Index) = 0.89, RMSEA (Root Mean Square Error of Approximation) = 0.06 and SRMR (Standardized Root Mean Square Residual) = 0.06. The three main factors for cocaine use were: pleasant and positive sensations, social pressure and self-esteem, and amotivation. This study laid the groundwork for the development of a valid questionnaire to explore and better understand the cocaine users' motivations, thereby enabling preventive and therapeutic measures to be adjusted accordingly. This questionnaire can also be used for future research on cocaine use, which is focused on mental health as well as family history and history of traumatic life events, as associated with cocaine use. We may also consider replicating this study on a clinical population with a cocaine-dependency diagnosis, potentially revealing additional motivations. [ABSTRACT FROM AUTHOR]

Le but de ce travail est d'explorer les multiples aspects du « Praecox Feeling » tels qu'il a été décrit par le psychiatre néerlandais H.C. Rümke et développé dans les suites par ses pairs. Nous proposons une présentation historique sur ce sujet allant des premières descriptions aux études les plus récentes. Nous proposons d'y associer des notions voisines telles que les processus de typification et le jugement expert (Gut feeling) en y intégrant des aspects épistémologiques. Le Praecox Feeling a été présenté par Rümke comme le moyen le plus sensible pour diagnostiquer une schizophrénie. Phénomène singulier de la rencontre clinique, il peut être décrit comme une expérience de bizarrerie ou d'étrangeté vécue par le clinicien au contact de son patient. Rümke conclut que le diagnostic de schizophrénie ne se fait pas strictement par une description précise des symptômes, mais en examinant son propre ressenti. De nombreux auteurs et chercheurs ont travaillé sur ce sujet et sont pour la plupart sensibles à une approche phénoménologique. Ainsi, Minkowski, Binswanger ou Tellenbach, parmi d'autres, ont permis d'affiner cette notion en parlant de « diagnostic par intuition », « diagnostic par pénétration » ou encore « diagnostic atmosphérique ». Malgré un abandon progressif de la subjectivité dans le processus diagnostique en psychiatrie, on retrouve dans la littérature contemporaine un regain d'intérêt de telles approches. On peut ainsi citer les processus de typifications ou encore le jugement expert (Gut feeling) qui proposent d'éclairer les mécanismes en jeu via une approche issue en partie des sciences cognitives et sociales. Ainsi, il apparaît que la question du diagnostic et de ses processus dépasse le strict champ psychiatrique pour rejoindre celui de la médecine au sens large. The aim of this review is to explore the multiple aspects of the « Praecox Feeling » as introduced and developed by the Dutch Psychiatrist H.C Rümke in 1941 and re-assessed over the following years by its peers. We present a historical review of this subject from the first description to the most recent research and proposed related notions like typification processes and gut feeling. The Praecox Feeling, as presented by Rümke, may be considered as the most sensible tool in order to diagnose schizophrenia. This phenomenon appears in the in-between of the clinical encounter (i.e. the intersubjective space). It may be felt by the clinician as an experience of bizarreness during the interaction with a patient suffering from schizophrenia. Those feelings suggest fundamental aspects of schizophrenia that can be recognized as a peculiar form of embodiment. Rümke finally concludes that schizophrenia is not diagnosed by strictly examining patients' symptoms, but psychiatrists' own feelings. The recognition of such feelings remains hard to describe explicitly, since it takes place in a very basic (« pre reflexive ») state. However, numbers of researchers tried to explore praecox feeling more accurately. A phenomenological approach, with Minkowski, Binswanger or Tellenbach among others, developed several related terms: "Diagnostic by intuition", "Diagnostic by penetration" or "Atmospheric diagnosis". Although the precocity of the diagnosis is mentioned in Rümke's original paper, it does not precisely define the Praecox Feeling, contributing to the misunderstanding of the Rümke's original formulation. The very notion of Praecox Feeling in terms of psychiatric diagnoses fell into disuse with the development and the widespread diffusion of criteriological approaches, with the risk of an impoverishment of the clinical diagnosis. However, the study of specific subjective perspectives showed a renewed interest over the last decade, especially with the contribution of cognitive and social neurosciences. Furthermore, studies on psychiatrists' daily-practice suggest that the Praecox Feeling is still relevant. Moreover, "the subjective tool" represented by the Praecox Feeling remains as used today as it was fifty years ago, in a pre-DSM III era. Temporal aspects have, nevertheless, lead to several studies suggesting that many clinical indices are identified during the first minutes of a clinical interview, especially for schizophrenia. In order to specify this very intuitive pathway, authors developed and worked on the typifications processes that lead to such feelings, involving diagnosis through prototypes. The passive synthesis of such subtle clinical clues may induce for the clinician a "pattern recognition" phenomenon that reminds a "gestaltic" diagnosis. This specific aspect of typification may not be specific of psychiatry. The "Guts Feeling" is a notion first developed by Dutchs physicians, particularly in General medicine but also among other medicals disciplines, theoretically very close from the notion of intuitive typification. It may allow benefits in term of diagnoses, reassurance or alarm sense. It suggests that clinical experience added to criteriology provides risks reductions. The crucial role of clinical experience in the diagnosis decision making tends to be underexplored, but still represents a crucial aspect of the evidence-based medicine as firstly described. [ABSTRACT FROM AUTHOR]

André Collin (1879–1926) a été le premier ou l'un des tout premiers à s'intéresser au développement neuropsychique du nourrisson avec une thèse portant sur le syndrome infantile psycho-neuromusculaire (1912). Interne de trois grands maîtres de l'aliénisme : Philippe Chaslin (1857–1923), Ernest Dupré (1862–1923) et Jules Séglas (1856–1939) et d'un pédiatre, Auguste Lesage (1862–1927), il a été chef de clinique de Gilbert Ballet (1853–1916) à l'asile Sainte-Anne de 1912 à 1914. A. Collin a assuré des consultations dans différents dispensaires et hôpitaux de Paris (Hérold, Marie-Lannelongue, Loubet), et il a en outre exercé de 1913 et jusqu'à son décès au Patronage de l'enfance situé au 379 rue de Vaugirard (Paris ; XIVe), une institution privée qui recueillait des mineurs livrés au vagabondage ou qui lui étaient confiés par le Tribunal pour Enfants. En 1925 sera annexée à ce patronage une clinique de neuropsychiatrie dirigée par Georges Heuyer (1884–1977). Membre de la Société Médico-Psychologique (1918), A. Collin est l'auteur de nombreuses communications, publications et de quatre ouvrages : Le développement de l'enfant (1914), Traité de médecine légale infantile (1920) publié avec Henri Rollet (1860–1934), Les enfants nerveux (1924) et Convulsions et épilepsie chez les enfants (1926). Des livres qui témoignent de son intérêt pour la psychiatrie et la neurologie de l'enfant. Dans les premières décennies du XXe, l'étude de l'aliénation mentale chez l'enfant marchait au côté de celle de l'adulte mais cherchait à acquérir son indépendance et à se définir. Dès 1915, les travaux de A. Collin reflètent sa préoccupation de spécifier la sémiologie psychopathologique ou neuropathologique chez l'enfant. En 1924, il fonde la psycho-pédiatrie qu'il considérait comme une branche de la puériculture. Il la définit comme l'étude des différentes modalités suivant lesquelles s'effectue chez le tout jeune enfant le passage de la vie végétative et réflexe à la vie consciente et réfléchie c'est-à-dire le passage de la première période du nourrisson où dominent ses réflexes simples à celle de son adaptation sociale où l'enfant est capable d'établir des rapports sociaux entre lui et le milieu nécessaire à son développement. Ayant connu l'introduction de la psychanalyse chez l'enfant, A. Collin montre peu d'enclin pour cette approche (1911). Dans les premières années du XXe siècle, les dénominations des consultations destinées aux troubles neuropsychiques chez l'enfant (centre psycho-pédiatrique, dispensaire médico-pédagogique, consultation de neuropsychiatrie infantile) et de ceux qui les assurent (psycho-pédiatre, spécialiste de psychiatrie infantile, médecin spécialisé en neuropsychiatrie infantile) sont nombreuses, et la psycho-pédiatrie, discipline éphémère, a été assimilée à la neuropsychiatrie infantile qui a pris son autonomie en 1937. A. Collin ayant accordé une place importante à l'étude du développement neurologique précoce de l'enfant, la psycho-pédiatrie figure comme l'une des assises de la neuropédiatrie contemporaine. André Collin (1879–1926) was the first, or one of the very first, to take an interest in the neuropsychological development of infants. During his studies at the School of Medicine in Paris, he wrote a thesis entitled The Infantile Psycho-neuromuscular Syndrome (1912). Previously, had served as an intern to three eminent alienists: Philippe Chaslin (1857–1923), Ernest Dupré (1862–1923) and Jules Séglas (1856–1939) and to a pediatrician, Auguste Lesage (1862–1927). From 1912 to 1914, he was the head of Gilbert Ballet's (1853–1916) clinic at the Sainte-Anne asylum. A. Collin practiced in various clinics and hospitals in Paris (Hérold, Marie-Lannelongue, Loubet), and from 1913 until his death in 1926, he worked at the Patronage de l'enfance, located at 379 rue de Vaugirard (Paris; 14th). It was a private institution founded by Henri Rollet (1860–1934). It took in vagrant minors or those who had been entrusted to it by the Children's Court. In 1925, a neuropsychiatric clinic directed by Georges Heuyer (1884–1977) was annexed to this patronage. A. Collin was a member of the medical-psychological society (1918). He has published numerous papers, publications, and four books: Le développement de l'enfant (1914), Traité de médecine légale infantile (1920), co-authored by Henri Rollet, Les enfants nerveux (1924) and Convulsions et épilepsie chez les enfants (1926). These works are a testament to his interest in child psychiatry and neurology. In the first decades of the 20th century, the study of mental alienation was not significantly different between adults and children, but the discipline dealing with child mental disorders strove to differentiate itself and achieve independence. As early as 1915, the publications of A. Collin reflected his preoccupation with specifying psychopathological or neuropathological semiology in children. In 1924, he founded psychopediatrics, which he considered to be a branch of childcare. He defined it as the study of the different ways in which the very young child makes the transition from a vegetative, reflexive life to a conscious, reflective life, i.e. the transition from the first period in an infant's life, when simple reflexes dominate, to the period of social adaptation when the child can establish social relationships between her/himself and the environment necessary for her/his development. Having experienced the introduction of psychoanalysis for children, Collin demonstrated little inclination for this approach. In his 1911 publication, he examined child urinary incontinence and cited S. Freud (1856–1939), which was rare at this time. In the early years of the 20th century, the institutions where consultations took place (psychopediatric centers, medical-pedagogical clinics, child neuropsychiatric consultations) and those who provided consultations for neuropsychiatric disorders in children (pediatric psychiatrists, child psychiatric specialists, physicians specialized in child neuropsychiatry) were called by many different names. Moreover, psychopediatrics, which was first introduced at the First International Congress of Child Psychiatry organized by G. Heuyer and held from 24 July to 1 August 1937, was a relatively short-lived discipline as it was assimilated into child neuropsychiatry, which became autonomous in 1937. Although A. Collin had passed away by that time, his emphasis on the study of neurological development during early childhood rendered psychopediatrics one of the foundations of contemporary neuropediatrics. [ABSTRACT FROM AUTHOR]

Dans cet article, l'auteure retrace les premiers moments de l'introduction de la psychanalyse en pédopsychiatrie et le contexte de leur émergence dans les années 1920 et 1930 en France. Ils sont contemporains de la difficile introduction de la psychanalyse dans l'univers médical. La psychanalyse de l'enfant apparaît alors comme une prophylaxie des troubles névrotiques et suscite l'intérêt des psychopédagogues et des éducateurs. L'auteure retrace les travaux pionniers de la psychanalyste Sophie Morgenstern au sein de la consultation de psychiatrie infantile de Georges Heuyer, et ceux de Pierre Mâle dans sa consultation de psychiatrie infantile à Henri Rousselle. Celui-ci deviendra, à la Libération, le spécialiste de la psychothérapie de l'adolescent. Cependant, l'héritage de Morgenstern va être oublié ou renié par ceux qui vont lui succéder, et elle s'interroge sur les raisons de ce phénomène. Ces travaux pionniers, qui dessinent un nouveau visage de l'enfance normale et anormale, vont connaître une forte expansion après la Seconde Guerre mondiale. In this paper, the author describes the first moments of the introduction of psychoanalysis in child psychiatry and the context of their emergence in the 1920s and 1930s in France. They are contemporaneous with the difficult introduction of psychoanalysis into the medical world. Child psychoanalysis then appeared as a prophylaxis of neurotic disorders, and aroused the interest of educational psychologists and educators. It traces the pioneering work of psychoanalyst Sophie Morgenstern in Georges Heuyer's child psychiatry consultation, and that of Pierre Mâle in Henri Rousselle's child psychiatry consultation. After the Liberation, he became the recognized specialist in adolescent psychotherapy. On the other hand, Morgenstern's legacy will be forgotten or disowned by those who will succeed her, and the author wonders about the reasons for this phenomenon. This pioneering work, which drew a new face of normal and abnormal childhood, was to be greatly expanded after the Second World War. [ABSTRACT FROM AUTHOR]

Dans cette communication, nous montrons que la littérature sur la prévalence des troubles psychiatriques et liés à l'usage de substances en milieu pénitentiaire est riche. Son interprétation se heurte toutefois à plusieurs difficultés : (i) une grande hétérogénéité des systèmes judiciaire et de soins de santé mentale entre les pays et (ii) des spécificités de l'environnement carcéral parfois négligées dans la méthodologie des études. Forts de ce constat, nous développons les résultats d'un certain nombre de travaux de référence sur la prévalence des troubles psychiatriques et liés à l'usage de substances dans les prisons françaises. Nous discutons enfin les perspectives en termes d'épidémiologie psychiatrique en milieu pénitentiaire. In this paper, we show that the literature on the prevalence of psychiatric and susbtance use disorders in prisons is substantial. However, there are a number of difficulties one encounters in interpreting this literature: (i) there is considerable heterogeneity between countries' judicial and mental health care systems, and (ii) the specific features of the prison environment are sometimes overlooked in the methodology used to conduct such studies. With this in mind, we discuss a number of benchmark studies on the prevalence of psychiatric and substance use disorders in French prisons. Finally, we discuss the perspectives for psychiatric epidemiology in prisons. [ABSTRACT FROM AUTHOR]

L'objectif de cet article est de proposer un état des lieux de la recherche sur les auteurs de violences conjugales en France en lien avec l'évolution des politiques publiques. La lutte contre les violences conjugales en France s'est particulièrement développée depuis une dizaine d'années, devenant Grande Cause du premier quinquennat (2017–2022) du Président de la République. Après le « Grenelle de lutte contre les violences conjugales » en 2019, une des mesures prises a concerné la création de Centres de prises en charge des auteurs de violences conjugales (CPCA). L'objectif premier des CPCA déployés en 2020 et 2021 sur l'ensemble du territoire national est de favoriser la prévention du passage à l'acte et de la récidive. Au regard de l'expérience internationale où ce type de prise en charge existe depuis les années 1980, cela pose la question de la structuration des pratiques et celle de procédures d'évaluation systématique des risques de violence. Parallèlement à l'amélioration des pratiques de prises en charge des auteurs de violences conjugales, un état des lieux de la recherche concernant les auteurs de violences conjugales en France est réalisé. Les recherches scientifiques en psychiatrie et en sciences humaines et sociales sont rares, qu'il s'agisse des recherches en sociologie, en droit, dans le milieu pénitentiaire ou dans le domaine médico-psychologique. The aim of this paper is to report on the current state of research into the perpetrators of intimate partner violence in France in relation to changes in public policy. In France, 22% of women aged 15–49 who are married or are in a relationship have been subjected to physical or sexual violence by their intimate partner. If we also take into account psychological violence, this figure rises to almost 60%. The fight against intimate partner violence has been gathering more and more impetus in France over the last ten years. The first Council of Europe Convention on preventing and combatting violence against women and domestic violence (Istanbul Convention) was adopted in 2011, and the first country-specific recommendations were made in 2015. Intimate partner violence became a major undertaking of the first five-year term (2017–2022) of the French President of the Republic. In September 2019, his government launched the "Grenelle" of fighting against intimate partner violence, which aimed to identify improvements in the implementation of previous initiatives and to transform professional practices. Included among the measures taken after the "Grenelle", was the creation of Centers for perpetrators of intimate partner violence ("Centres de prise en charge des auteurs de violences conjugale": CPCA), and their implementation in 2020–2021 marked a real turning point, at a time when the care of perpetrators had previously received little attention from public policy in France. Other measures will follow, notably those recently introduced in order to better deal with family violence in the courts. Evaluation of these policies shows that there is still considerable room for improvement, but there is currently momentum for further progress, with a clear desire displayed for public authorities to step up their efforts. The primary objective of the CPCA is to stop intimate partner violence and reoffending from happening again. However, they were set up without any standards having been established, e.g. in terms of theoretical references or intervention approaches, as is the case in other countries (United States, United Kingdom, Canada) where the adoption of standards of practice has been gradual over 20 or 30 years. The lack of systematic risk assessment procedures for intimate partner violence in France can also be noted. In the same vein, this work provides an overview of research into the perpetrators of intimate partner violence in France. It reports on national statistical and demographic surveys, and on research in sociology, law, prison administration and the medical-psychological field. Scientific research focusing on the perpetrators of intimate partner in France is rare in psychiatry and the humanities and social sciences. Finally, a research project entitled "A portrait of practices with perpetrators of intimate partner violence and their impact: a case study of 7 to 8 centers which take care of them" funded by the French Ministry for gender equality, diversity and equal opportunities (2023–2024), is presented. [ABSTRACT FROM AUTHOR]

L'obligation de soin est une mesure instaurée depuis le 23 novembre 1958 en même temps que la peine d'emprisonnement assortie d'un sursis avec mise à l'épreuve. Peu usitée à l'origine, cette obligation semble aujourd'hui faire l'objet d'un prononcé de plus en plus fréquent. Concernant essentiellement la population des hommes présentant des troubles de la personnalité ou des troubles liés à l'usage de substances psychoactives, les thérapeutes seront fréquemment sollicités par leurs patients pour mettre en œuvre cette mesure. À travers une revue de la littérature juridique et sanitaire, l'article tentera de préciser ce que recouvre l'obligation de soins, quelles sont les conditions dans lesquelles elle est prononcée, comment elle se déroule puis s'achève. Mandatory care is part of court-ordered care. This measure was introduced into French Law on November 23, 1958, at the same time as conditional imprisonment with probation. Rarely used by judges in the beginning, mandatory care appears to be ordered more frequently today. Concerning mainly male individuals with personality or substance abuse disorders, therapists will frequently be asked by their patients to implement this measure. Through a review of the legal and health literature, this paper intends to specify how mandatory care is ordered, implemented, applied and ultimately how it ends. We conducted a literature review of French legal and health publications between 1958 and 2021. We included sources from several databases such as Science Direct, Persée, Cairn, Dalloz, and Légifrance. We used the keywords "obligation de soin", "soins pénalement ordonnés". Mandatory care is a frequent measure that can be pronounced by French judges at any judicial procedure. No psychiatric expertise is needed contrary to other court-ordered care such as injunction of care. As the magistrate only sets the goals of mandatory care, its organization and extent are determined by the therapist in partnership with the patient. The patient will then have to prove his assiduity to the judge, by asking the therapist to submit certificates of attendance. As the therapist is sworn to respect the professional secrecy towards the magistrate, the judge should transmit all the documents useful for the patient's care. Finally, mandatory care can be terminated at the behest of the patient, the district attorney, or the Executive Magistrate. It seems essential that healthcare professionals understand what mandatory care is and how it is conducted. Moreover, we invite all those involved, from the judicial to the medical system, to promote meeting venues to better identify the limits of each, while, at the same time, respecting one another's professional secrecy. [ABSTRACT FROM AUTHOR]

Peut-on raisonnablement défendre la suppression de l'évaluation du discernement dans l'appréciation de la responsabilité pénale des infracteurs ? Si une telle question peut à première vue sembler purement rhétorique, de récentes propositions de réforme de l'article 122-1 du Code pénal suggèrent qu'il n'en est rien. Une recommandation, publiée dans les Annales Médico-Psychologiques (Bouchard, 2018), de réécriture dudit article s'appuie même explicitement sur une argumentation en faveur de l'abandon des concepts – légitimement jugés insuffisamment précis – d' abolition et d' altération du discernement, auxquels devrait se substituer l'idée, supposément moins équivoque, d'un lien de causalité nouant (de façon « exclusive » ou non) la présence d'un trouble mental et la commission des faits. Nous nous proposons ici de démontrer en quoi le raisonnement censé justifier l'évacuation de l'examen de la qualité du discernement – remplacé par une estimation de type causal particulièrement ambitieuse – repose sur des prémisses éminemment controversables et nous achemine en outre vers d'insurmontables difficultés évitées par le texte actuel. Can one reasonably defend the suppression of the investigation of discernment in the assessment of the criminal responsibility of offenders? While such a question may at first glance seem purely rhetorical, recent proposals for reform of article 122-1 of the Penal Code suggest that this is not the case. A recommendation, published in the Annales Médico-Psychologiques (Bouchard, 2018), to rewrite this article is in fact explicitly based on an argument insisting on the desirable removal of the concepts – legitimately judged insufficiently precise – of abolition and alteration of discernment , which should be replaced by the idea, supposedly less equivocal, of a causal link ("exclusive" or not) between the presence of a mental disorder and the commission of the offence. In this paper, we propose to demonstrate how such an evacuation of the examination of the quality of discernment – intended to be replaced by a particularly ambitious causal type analysis – is incoherent and moreover produces insurmountable difficulties avoided by the current text. [ABSTRACT FROM AUTHOR]

Dans cet article, les auteurs présentent la Palette des émotions, une médiation graphique facilitant l'expression du vécu émotionnel des patients après une mesure d'isolement. Dans le cadre d'une politique de réduction de l'isolement et de la contention, les auteurs montrent en quoi l'approche relationnelle basée sur cette médiation peut favoriser l'amélioration de ces pratiques et constituer un outil de prévention tertiaire. À partir d'une revue ciblée de la littérature sur le thème de l'isolement et de la contention, qui montre l'intérêt du recueil du vécu des patients, les auteurs décrivent la conception et la procédure d'utilisation de la Palette des émotions, ainsi que l'approche relationnelle qu'elle implique. Trois vignettes cliniques sont proposées afin d'illustrer le propos. En facilitant l'expression des émotions ressenties dans le cadre d'une mesure d'isolement, la Palette des émotions reconnaît la valeur de l'expérience du patient et induit une dynamique relationnelle qui lui permet de recouvrer une position active dans le soin. S'il révèle un vécu essentiellement négatif autour de l'épisode d'isolement, le recueil des émotions l'amène aussi à envisager des améliorations et des alternatives aux pratiques coercitives. Dans la mesure enfin où son utilisation comporte une discussion des résultats au sein de l'équipe soignante, la Palette des émotions favorise une approche éthique et thérapeutique valorisant l'écoute et la prise en compte de l'expérience de l'usager. Les cas cliniques illustrent ces différents points. L'utilisation de la Palette des émotions et les témoignages cliniques qui en sont issus font ressortir la plus-value éthique et thérapeutique potentielle de cet outil. The use of seclusion and restraint within mental health settings has long been considered controversial. According to the literature, patient experiences of seclusion and restraint are mainly negative, harmful or traumatic. Patients express a need to discuss the seclusion or restraint event and their feelings afterwards. This paper describes the Emotional Palette, a graphical tool for enhancing patients' expression of emotional experience after seclusion or restraint. On the basis of a focused review of literature, demonstrating the relevance of investigating patients' experiences after seclusion or restraint, this article presents the Emotional Palette, a graphic tool created in a psychiatric ward for helping patients express their emotional experience. This graphical tool (figure 1) consists of a coloured checkerboard which presents terms typically used to express emotions relating to seclusion or restraint's experience. Each term is associated with a colour, ranging from red (negative feeling) to white (intermediate feeling) and green (positive feeling). Patients are interviewed a few days after seclusion. Firstly, they are asked to complete three Emotional Palettes, which refer to three moments of their experience : the time when they were put inside the seclusion room, the time spent during the seclusion process, and the time after the seclusion. For each moment, patients identify the predominant emotions on the corresponding Palette. After completing the Palettes, they are interviewed. The aim is to promote a relationship of confidence to make the persons feel free to say what they like. They are also encouraged to express their own proposals for alternative methods and suggestions for improving seclusion practice. In this article, the usefulness of the approach based on this tool is discussed within three clinical case studies. For each patient the result of the Emotional Palette was transcribed and a thematic analysis was used to analyse the verbatim. The seclusion-related negative emotions mainly identified by patients were fear, anger, boredom, helplessness, resignation, loneliness and humiliation. Negative feelings were linked to perceived lack of interaction with the staff before and during seclusion. Patients reported that they were not given enough information about the reason for their seclusion and what would happen next. After the seclusion process, they mentioned positive experiences such as finding calm, gratitude and confidence in the nursing staff. Some patients' suggestions regarding the improvement of seclusion practices were related to a need for more interaction with nurses and doctors. These emotions and views expressed by patients echo the findings of previous studies and surveys. Beyond these results, the main benefit lies in the fact that, by giving the opportunity to have a debrief, the Emotional Palette tends to strengthen the patient's position and involvement. All of them expressed a satisfaction to be able to discuss the seclusion event and their feelings afterwards. They suggested alternatives to seclusion that could expressly work for them (one-to-one intervention, specific activities..). They stressed the importance of interaction with the nurses and the doctors, through empathetic listening, attention and understanding, active communication and for more staff presence in the ward. Thanks to the Emotional Palette, patients experienced that their views and emotions had been heard and recognized. Finally, by giving every patient an opportunity to discuss his/her experience with the staff, the Emotional Palette helps to develop a personal prevention strategy that could offer alternative methods for seclusion in case of crisis. Future research is needed to provide generalizable data and validate the usefulness of the Emotional Palette. By helping patients to express their emotions after a seclusion process, the Emotional Palette offers a framework and a therapeutic approach which prove useful in regaining a positive interpersonal relationship with a patient. By allowing the patient to give their views and suggestions for improvement and alternatives, this tool could also constitute a means to reduce seclusion practices. [ABSTRACT FROM AUTHOR]

La maladie d'Alzheimer et les maladies apparentées entraînent des troubles de l'humeur et des troubles anxieux chez les résidents institutionnalisés. La thérapie par réminiscence a démontré un intérêt dans le traitement de ces symptômes. L'étude pilote randomisée « Réminiscences et Émotions » utilise la réalité virtuelle personnalisée pour diminuer les troubles de l'humeur des résidents. Les objectifs secondaires visent à évaluer l'acceptabilité du dispositif et la qualité de vie des résidents. Monsieur G. présente des troubles cognitifs modérés ainsi que des troubles de l'humeur. Il participe à dix séances de réalité virtuelle personnalisée pendant une période de six semaines. Les variables sont mesurées en amont et à la fin du protocole. Une analyse visuelle des scores illustre les résultats. Le dispositif de réalité virtuelle est accepté et toléré par le participant. Les scores aux échelles de l'humeur (dépression, apathie) et de l'anxiété diminuent. Aucune différence n'apparaît sur l'échelle de qualité de vie. Les interventions génèrent du plaisir et de la vivacité en lien avec l'émergence de souvenirs positifs. Il existe un intérêt de la thérapie par réminiscence en réalité virtuelle pour améliorer l'humeur du participant. Les futurs résultats permettront de conclure sur la méthode et son indication thérapeutique en institution gériatrique. The World Health Organization defined dementia as a syndrome in which there is deterioration in cognitive function beyond what might be expected from the usual consequences of biological aging. Currently, 55 million people live with Alzheimer's in the world. Unfortunately, there isn't any drug treatment to cure the degenerative disease although clinical trials are promising regarding the use of monoclonal antibodies. But, Alzheimer's disease and associated diseases lead to behavioral and psychological symptoms (anxiety, apathy, depression) which can be frequent in nursing homes. In the context of pandemic, these conditions are amplified because of the sanitary restrictions. Since the beginning of the sars-cov2 pandemic, residents have felt alone, sad and more anxious. Nowadays, non-drug interventions are recommended by health organizations for the treatment of behavioral and mood disorders in the elderly with cognitive disorders. Reminiscence therapy is a non drug intervention which has been shown to be effective in the treatment of mood disorders on elderly. Many nursing homes use this non pharmacological treatment for their residents. Some studies take interest in reminiscence and virtual reality. The use of new technologies is innovative in geriatric care and it can be used as a personalized support for reminiscence therapy. The "Bien Vieillir Nice 2030" Project of Nice's University Hospital supports this research on virtual reality and mood disorders in nursing homes/long term care unit. The objective of this study (University Hospital of Nice, CoBTeK France) is to evaluate the effects of personalized virtual reality on reduction of mood disorders in nursing homes residents with minors and moderates neurocognitive disorders. The secondary objectives are to assess the acceptability of the device, the emotional valence and the resident's quality of life. A single case study is presented to illustrate reminiscences and emotions protocol. Participants are randomized into two groups: neutral versus personalized. The neutral videos consist of unknown places like random streets or public gardens while the personalized videos are known places that mattered to the residents. Places are filmed with a camera GoPro Fusion 360°. The healthcare team and families are actively involved in the research protocol. Their help is invaluable in targeting memories related to the resident's life history. A clinical psychologist specializing in gerontology is in charge of the virtual reality sessions. The therapeutic alliance is central to our study. A humanistic method of person-centered approach allows communication with the resident to offer him to participate in the sessions. The sessions always start and end in the same way in order not to cause stress in the resident. The hardware is tested before the protocol starts, for familiarization purpose. Potential side effects related to virtual reality are identified using a cybermalaise questionnaire. The sessions are held in a sitting position for the participant's safety. In this paper, Mr. G, 92 years old benefits from personalized video according to his life story. He has moderate cognitive impairment as well as mood disorders. He received ten virtual reality sessions over a period of six weeks. The exposure time varies between five to ten minutes. We use an Oculus Rift S headset and a computer in partnership with C2Care. Variables were measured before and at the end of the protocol. We performed a visual analysis of the scores. The results indicated a decrease on mood rating scales scores (Geriatric Depression Scale, Apathy Inventory, Neuropsychiatric Inventory and Hamilton Depression Rating scale). The interventions produced pleasure and alertness in connection along with the emergence of positive memories. The headset was well tolerated by the participant, but we did not observe any effect on quality of life. There is an interest in the use of reminiscence therapy using virtual reality to improve participants' mood. Future results will allow us to conclude on the method and on its indication in nursing homes after the inclusion of 30 participants. [ABSTRACT FROM AUTHOR]

From 2018 to 2022, the Lebanese Association of Victims of Terrorism (AVT-L), in collaboration with the United Nations (UNODC, United Nations Office for Drug and Crime) and with the support of the government of the Netherlands, conducted a project to provide psychological care to victims of terrorism in Iraq. Ninety Yezidi women participated in this program. Each participant had experienced sexual violence during the control of part of Iraqi territory by the jihadists of the Islamic State group (ISIS) between 2014 and 2018. After a semi-structured interview, these Yezidi women first participated in experience-sharing sessions for three consecutive days. Then, they benefited from an individual psychological follow-up for 6 months. Over the last ten years, the association's team has developed a protocol that combines art therapy with group and individual psychotherapy. The care is regularly evaluated. From the first interview, the psychologist uses the results of the Traumaq. An evaluation tool that assesses trauma-related symptoms. Subsequently, the PCL5 scale is used to measure the evolution of the symptoms. A considerable support that is studied in resonance with the life story and the social, personal, and professional evolution of each person. At the end of the psychological support sessions, significant changes were observed, particularly for criteria B and D of the DSM-5. We recorded a reduction in intrusive memories, as well as an improvement in emotional and physical reactions to these memories. Feelings of guilt had subsided and a significant improvement in sleep and concentration was noted. Participants experienced an improvement in their self-esteem, with a desire to pursue studies and active projects in their community. However, anger regarding injustice and lack of compensation remains palpable. This work culminated in supporting and accompanying these women in making their voices heard at the United Nations headquarters in New York. In this paper, we will highlight the beneficial aspects of art therapy used in this program. We will emphasize the value of clay art therapy particular within this context. [ABSTRACT FROM AUTHOR]

De 2018 à 2022, l'Association libanaise des victimes du terrorisme (AVT-L), en collaboration avec les Nations unies (United Nations Office for Drug and Crime [UNODC]) et avec le soutien du gouvernement des Pays-Bas, a mené un projet de prise en charge psychologique de victimes du terrorisme en Irak. Quatre-vingt-dix femmes yézidies ont participé à ce programme. Chacune des participantes a subi des violences sexuelles pendant la prise de contrôle d'une partie du territoire irakien par les jihadistes du groupe État islamiste (Daech) entre 2014 et 2018. Après un entretien semi-directif, ces femmes yézidies ont d'abord participé à des séances de partage d'expérience pendant trois jours consécutifs. Ensuite, elles ont bénéficié d'un suivi psychologique individuel pendant six mois. Depuis dix ans, l'équipe de l'association a développé un protocole qui allie l'art-thérapie et la psychothérapie groupale et individuelle. La prise en charge est régulièrement évaluée. Dès le premier entretien, le psychologue se base sur les résultats du Traumaq, un outil d'évaluation qui permet d'évaluer les symptômes liés au traumatisme. Par la suite, l'échelle PCL-5 est employée pour mesurer l'évolution des symptômes. Un appui considérable qui est étudié en résonance avec le récit de vie et l'évolution sociale, personnelle et professionnelle de chacune. À la fin de la prise en charge, des modifications significatives ont été observées, notamment pour les critères B et D du DSM-5. Nous avons enregistré une réduction des souvenirs intrusifs, ainsi qu'une amélioration des réactions émotionnelles et physiques face à ces souvenirs. Le sentiment de culpabilité s'est apaisé avec une amélioration notable du sommeil et de la concentration. Les participantes ont constaté une amélioration de leur estime de soi, avec l'envie d'entamer des études et de développer des projets actifs pour leur communauté. Cependant, la colère concernant l'injustice et le manque d'indemnisation reste palpable. Ce travail a été couronné par l'accompagnement d'une délégation de ces femmes pour faire entendre leur voix au siège des Nations unies à New York. Au cours de cette communication, nous allons présenter la partie art-thérapie de ce dispositif. Nous soulignerons l'intérêt que l'art-thérapie par l'argile apporte dans ce cadre. From 2018 to 2022, the Lebanese Association of Victims of Terrorism (AVT-L), in collaboration with the United Nations (United Nations Office for Drug and Crime [UNODC]) and with the support of the government of the Netherlands, implemented a project to provide psychological care to victims of terrorism in Iraq. Ninety Yezidi women participated in this program. Each one of the participants had experienced sexual violence during the takeover of part of the Iraqi territory by the jihadists of the Islamic State group (ISIS) between 2014 and 2018. Following a semi-structured interview, these Yezidi women first participated in experience-sharing sessions for three consecutive days. Then, they benefited from an individual psychological follow-up for a period of 6 months. Over this ten-year period, the association's team has developed a protocol that combines art therapy with group and individual psychotherapy. The care is evaluated on a regular basis. From the first interview, the psychologist uses the results of the Traumaq, an evaluation tool that assesses trauma-related symptoms. Subsequently, the PCL-5 scale is used to measure the evolution of the symptoms. A considerable support that is studied in association with the participant's life story and the social, personal, and professional evolution of each person. At the end of the treatment, significant changes were observed, particularly for criteria B and D of the DSM-5. We recorded a reduction in intrusive memories, as well as an improvement in emotional and physical reactions to these memories. Feelings of guilt were reduced. Significant improvement in sleep and concentration was also noted. Participants experienced an improvement in their self-esteem, with a desire to pursue studies and be involved in active projects in their community. However, anger about injustice and a lack of compensation remained palpable. This work culminated in the accompaniment of a delegation of these women to make their voices heard at the United Nations headquarters in New York. In this paper, we will highlight the art therapy aspect of this program, especially that of using clay as the medium for the art therapy. [ABSTRACT FROM AUTHOR]

En France, l'évaluation structurée du risque de récidive est peu développée face au jugement professionnel non structuré, pourtant moins valide. Cet article propose une revue systématique de la littérature, répondant aux critères PRISMA, sur la perception et la pratique de l'évaluation structurée, en France, chez les professionnels concernés. Les mots clés « Évaluation du risque » AND « récidive » AND « France » ont été recherchés dans Pubmed, PsycInfo, Cairn et ScienceDirect. Les 23 articles obtenus dans les résultats montraient des craintes et peu d'avantages concernant l'évaluation structurée, la possibilité d'un système hybride et les quelques travaux français utilisant des échelles de risque. Ces réticences concernaient : (i) le système judicaire français (notamment le tout actuariel) ; (ii) les professionnels évaluateurs (confusion des rôles entre professionnels) ; (iii) les personnes évaluées (risque de stigmatisation des infracteurs à haut risque) ; et (iv) les outils eux-mêmes (prédictivité modérée). La validité scientifique, clinique et les garanties éthiques des échelles structurées du risque sont pourtant suffisantes pour permettre leur développement en France. Quelques hypothèses sont avancées pour expliquer les réticences à leur généralisation en France. In France, the recidivism of offenders (both sexual and non-sexual violence) is a national concern as evidenced by the media and the succession of laws relating to the prevention of recidivism. Risk assessment can be performed using unstructured professional judgment which is unreliable or by structured risk assessment which are more reliable. Abroad, this structured assessment is considerably developed. In France, it gives rise to two opposing positions: (i) encouragement by public authorities; and (ii) fear by a majority of professionals in the field. This article offers a systematic literature review, meeting PRISMA criteria, on the perception and practice of standardized evaluation in France by the professionals concerned. The keywords "Risk assessment" AND "recurrence" AND "France" were searched in French and in English in the search engines Pubmed, PsycInfo, Cairn, and ScienceDirect. The 23 articles obtained in the results highlighted: (a) fears and few advantages regarding the use of structured evaluation; (b) a possibility of a hybrid evaluation system in France; and (c) a report of some works already using scales of risk on French populations. This article focused mainly on the fears and perceived benefits of structured risk assessment. The reluctance has concerned both: (i) the French judicial system (fear of a new penology based only on the actuarial approach and its consequences); (ii) the professional valuers (fear of a confusion of professional's roles in health and justice fields); (iii) the persons assessed (fear of a risk of stigmatization of high-risk patients concerning violence); and (iv) the tools themselves (fear of a poor reliability of the risk assessment). Very few articles highlighted their advantages: reliability, simplicity of use, good inter-judge fidelity, guideline for care, and specially an ability to overcom the insufficient basis for the evaluation resulting from unstructured clinical judgment. Results also suggested the possibility of a hybrid evaluation system in France, which could rely on risk scales, without neglecting the interview and the qualitative collected information that have to respect precise steps and allow the management of offenders. Finally, this paper presented the few French studies using risk scales mainly focused both in sexual offenders' risks and associated factors, and showing a better productivity of these scales than an unstructured professional judgment. Fears related to the structured risk assessments are important. However, these scales may also supply a better vision of offenders. They require skills of professionals from various fields and allow both a fairer assessment of the offender and a penal system more adjusted. This perceived reluctance seems to be due to a poor knowledge of structured assessment the risk scales and a lack of research studies using them in France, where it is necessary to have a broad reflection on their development in the future. [ABSTRACT FROM AUTHOR]

Cette communication cherche à établir les apports des discussions et des contributions des membres de la Société Médico-Psychologique (SMP) à l'histoire de la psychiatrie légale en France pendant le siècle qui a suivi sa naissance en 1852. Les discussions du Second Empire et des débuts de la Troisième République sur les aliénés criminels, l'assistance, les aliénés dangereux, les aliénés avec conscience, sont résumées. Des articles de synthèse du milieu du XXe siècle sur la loi de 1838 (Desruelles), la médecine légale psychiatrique (Heuyer), l'évolution de l'assistance de 1789 à 1838 (Bollotte) et de 1838 à 1939 (Demay), sont analysés. Les grandes thématiques de la psychiatrie légale ont été traitées en profondeur à la SMP, sous les angles clinique, juridique et philosophique, dans trois registres : 1̊ l'état dangereux : rapports entre aliénation et criminalité, responsabilité des aliénés délinquants, critères de dangerosité des différentes catégories d'aliénés raisonnants et/ou avec conscience ; 2̊ l'assistance hospitalière et extra-hospitalière : activités des patients, colonies et placements familiaux, prise en compte de la chronicité, puis premiers services ouverts ; 3̊ la loi de 1838 et ses projets de réforme : rôles respectifs des autorités administrative et judiciaire, établissements privés, intégration des services ouverts et des suivis ambulatoires après 1945. Au XIXe siècle, le travail des malades (en général agricole) est mis en avant, avec la notion d'un rendement économique qui fait écran à sa fonction thérapeutique. Les débats occupant plusieurs séances cessent après 1880 de porter sur des thèmes spécifiquement médico-légaux. À la jonction des XIXe et XXe siècles, la prégnance de la dégénérescence, puis des thèses de Cesare Lombroso, éclipsent la philanthropie de la période précédente. Durant les années qui précèdent la guerre de 1914, la question de la responsabilité est traitée dans d'autres enceintes que la SMP. Au sortir de la Seconde Guerre mondiale, la mortalité par famine dans les asiles n'est abordée qu'allusivement. Dans le contexte idéologique de l'époque où elles ont été publiées, des contributions décisives ont été apportées entre 1852 et 1946 par la SMP à des questions qui vont structurer jusqu'à nos jours la législation et l'assistance psychiatriques : d'une part, organisation des services hospitaliers, modalités de placement des malades mentaux, ergothérapie, formes de suivis extra-hospitaliers, ébauche d'une organisation sectorielle des soins ; d'autre part, criminologie, dangerosité et responsabilité juridique des patients psychiatriques, expertise mentale. This paper seeks to establish the contribution of the discussions of the Société Médico-Psychologique (SMP) to the history of forensic psychiatry in France during the century following its birth in 1852. We summarize the discussions held during the Second Empire and the beginning of the Third Republic, about the criminally insane, the dangerously insane, the insane with consciousness and about assistance. Synthesis articles published from the middle of the 20th century on the law of 1838 (Desruelles), psychiatric forensic medicine (Heuyer), assistance from 1789 to 1838 (Bollotte) and from 1838 to 1939 (Demay), are analyzed. The principal themes of forensic psychiatry have been treated in depth at the SMP, in their clinical, juridical and philosophical aspects. The paper contains three chapters: (1) dangerous lunatics: the association between insanity and criminality, the responsibility of delinquent insane persons, the criteria of dangerous behavior in "reasoning" lunatics and in lunatics with consciousness; (2) inpatient and outpatient care: patient activities, colonies and family placements, chronicity in asylums, incurable lunatics, and the first open-door services; (3) the law of 1838 and its projects of reform: the respective roles of administrative and judicial authorities, private establishments and religious hospitals, the integration in the law of open-door services and outpatient follow-up after 1945. In the 19th century, the economic value of the patients' work (generally agricultural) was put forth and took precedent, over its therapeutic function. After 1880, the great debates over several months and sessions ceased to deal with specific forensic themes. At the end of the 19th century and the beginning of the 20th, the prevalence of degeneracy and the theses about criminals of the Italian Cesare Lombroso eclipsed the philanthropic concerns of the previous period. During the years just prior to World War I, the theme of responsibility is treated in other forums than by the SMP. After the Second World War, mortality due to starvation in asylums for lunatics was only slightly alluded to. In the ideological context of the period in which they were published, decisive contributions were made between 1852 and 1946 by the SMP in several domains, and which will have a bearing on psychiatric legislation and care up to the present day: on the one hand, the organization of hospital services for the mentally ill patients, occupational therapy, forms of outpatient follow-up care, the beginnings of a sectorial organization of care and ergotherapy in the institutions. On the other hand, criminology, knowledge about dangerous behavior and the responsibility of psychiatric patients, and in forensic expertise. [ABSTRACT FROM AUTHOR]

La prévalence de l'hyperactivité/TDAH fait l'objet d'intenses débats au niveau international. En France, la seule étude disponible pointe un taux de prévalence du TDAH de 3,5 à 5,6 % des enfants âgés de 6 à 12 ans. Les auteurs estiment également que 3,48 % des 6–12 ans sont traités par psychostimulant. Notre article s'appuie sur les données de l'Assurance Maladie pour discuter ces résultats. Il est possible de procéder à une étude rigoureuse du taux diagnostic et du niveau de prescription du méthylphénidate en France en analysant les données de l'Assurance Maladie. Dans cette perspective, nous avons utilisé les informations extraites de la base du Système National d'Information Inter-Régime de l'Assurance Maladie (SNIIRAM) présentées en 2017 dans un rapport de l'Agence Nationale de Sécurité du Médicament et des produits de santé (ANSM). Les données de l'Assurance maladie permettent d'établir une estimation de la prévalence du TDAH de 0,3 % en France. Ce résultat appelle des investigations plus approfondies dans la base du SNIIRAM. Il questionne les raisons du faible taux de médication du TDAH en France en comparaison d'autres pays occidentaux. Il interroge les biais méthodologiques et les conflits d'intérêts susceptibles d'orienter les études de prévalence du TDAH en France et au niveau international. Prevalence estimates for ADHD have therefore been at the core of an international debate in the last two decades. In France, the only available study carried out telephone inquiries in 2008 from a 7912 randomly selected sample of households. The researchers estimated 3.5% children suffered from ADHD, while 2.2% other children were treated with psychostimulants for attention deficit or hyperactivity symptoms without having formally been diagnosed. The use of a rigorous scientific approach and a strong methodology let the authors conclude the prevalence rate of children suffering from ADHD in France ranged from 3.5 to 5.6%. They also noted that among the 3.5% of children who were diagnosed with ADHD, 36.5% were being treated with methylphenidate. Therefore, they estimated 3.48% of children aged 6–12 were effectively treated with psychostimulants. In 2017, a report was issued by the National Agency for Medicines and Health Products Safety using data from The French National Social Security System (SNIIRAM) concerning methylphenidate consumption among children aged 6–11. This report showed 19,613 children aged 6–11 were effectively treated with methylphenidate in 2014. The study also states the prescription rate for methylphenidate increased by 44% between 2008 and 2012, then again by 13% between 2013 and 2014, though 34.2% of the children being treated with methylphenidate are not diagnosed as suffering from ADHD but from other psychiatric pathologies. Our paper compares these two data sets: one concerning ADHD prevalence and the ratio of ADHD children treated with methylphenidate in France, the other regarding the provision of methylphenidate-based medication among children. We highlight the gap between the two studies' results and call for supplementary investigations of the French Healthcare Insurance database as a way to obtain better information on ADHD diagnosis and medication in France. Methylphenidate is the only psychostimulant which prescription is authorized in the case of an ADHD diagnosis in France. To determine the prevalence of methylphenidate-based medication use in children aged 6–11, we first collected data concerning methylphenidate consumption from the SNIIRAM database and analyzed them in regard to the 2008 demographic survey issued by the National Institute for Statistics and Economic Studies (INSEE). Using this information and ADHD prevalence data, we secondly inferred an ADHD diagnosis rate in France. Consequently: Since methylphenidate is the only drug precription in France for ADHD, without any other therapeutic authorization; By taking into account (1) the ratio of children diagnosed ADHD and treated with methylphenidate in France (36.5%) and (2) the data concerning methylphenidate consumption in France (19,613 children aged 6–11 in 2014); It is possible to obtain accurate information on ADHD diagnosis in France from the provision of methylphenidate-based medication. We finally compared the prevalence rate of methylphenidate prescription and the estimation of ADHD diagnosis as reported in the SNIIRAM database, to the psychostimulant consumption level and the ADHD prevalence rate as highlighted in the initial prevalence study. Figures extracted from the SNIIRAM database show 19,613 children aged 6–11 were effectively treated with methylphenidate in 2014. Knowing the prescription rate for this molecule and this population increased by 44% between 2008 and 2012, then again by 13% between 2013 and 2014, we calculated methyphenidate consumption concerned 9555 of children aged 6–11 in 2008. Comparing this number to the National Institute of Statistics and Economic Studies (INSEE) children census, which reported 4,752,571 French children in 2008 1 1 Those figures are available at: https://www.insee.fr/fr/statistiques/2016358?geo=FE-1&sommaire=2133806#consulter-sommaire. , one can estimate about 0,2% of children aged 6–11 were effectively given methylphenidate that year. If 9555 of children aged 6–11 were treated by methylphenidate in 2008 according to the French National healthcare insurance system, and if 36.5% of ADHD children are treated with methylphenidate in France, then a correct estimate of the number of children who had been diagnosed with ADHD in 2008 would be 9555 + 9.555 × 0.635 = 15,622 children. This would mean around 0.3% of this population was diagnosed with ADHD in France in 2008. The real methylphenidate consumption rate among 6–11 children in France is at best 17 times lower than the estimation initially provided by the Lecendreux et al. prevalence study (0.2% the 6–11 children versus 3.48% of the 6–12 aged children). The discrepancy we highlight in this paper questions conflicts of interest and methodological biases at work in telephone inquiries or in any indirect methodology willing to establish ADHD prevalence rates. The results we present in this communication support more in-depth investigations of the SNIIRAM database when it comes to determining precise ADHD diagnosis and methylphenidate prescription rates in France. Accessing national, official databases would give researchers relevant information concerning potential variations in diagnosis and prescription rates over time, according to regions and hospitals, the age of the child at the time of diagnosis or treatment initiation, multiple co-morbidities and prescriptions outside of recommendations, associated therapeutic practices (psychotherapy), etc. Such complementary studies could also shed light on the factors contributing to the low rate of prescription drugs in the treatment of ADHD in France. [ABSTRACT FROM AUTHOR]

L'exercice physique pathologique est souvent au cœur du portrait clinique des patients présentant un trouble des conduites alimentaires. Or, peu de recommandations provenant des données probantes sont actuellement disponibles pour guider les intervenants dans la prise en charge des patients dits « exerciseurs ». Cet article a pour objectif de présenter l'état des connaissances actuelles quant aux traitements proposés ciblant spécifiquement l'exercice physique pathologique chez les patients présentant tout type de trouble des conduites alimentaires. Cette recension indique des bénéfices des traitements d'exercice physique adapté et de thérapie cognitivo-comportementale, principalement. En outre, les traitements devraient inclure des séances de psychoéducation, promouvoir des séances d'exercice physique hédoniques en groupe, proposer une diversité de mouvement et inclure des séances de repos et de relaxation. Les recommandations dégagées par cette recension indiquent la nécessité de prendre en charge l'exercice physique pathologique à partir d'une équipe clinique interdisciplinaire, voire transdisciplinaire, afin d'adresser de façon holistique un phénomène multidimensionnel et complexe qu'est l'exercice physique pathologique. Pathological physical exercise is a central feature of eating disorder and is related to a poor prognosis. Only few evidence-based recommendations are currently available to guide caregivers in the management of "exerciser" patients. Objective. The purpose of this paper is to present the current state of knowledge regarding proposed treatments targeting specifically the management of pathological physical exercise in patients with any type of eating disorder. The literature search took place in March 2020 and has been updated in February 2021 in databases (PsycINFO, PubMed, MEDLINE, SPORTDiscuss, etc.). English keywords encompassing concepts associated with pathological physical exercise, any type of eating disorder, and treatment were used in various combinations. To be included in the study, the publications identified must be written in English or French and be quantitative or qualitative empirical articles, systematic reviews of the literature or meta-analyses, case studies or syntheses of clinical guidelines. The synthesis of the studies highlights four main classes of pathological physical exercise treatment: adapted physical exercise treatment (n = 6), cognitive-behavioral therapy (n = 4), thermoregulation (n = 1) and pharmacotherapy (n = 1). The summary of currently available treatments for pathological exercise indicates benefits of adapted physical exercise and cognitive-behavioral therapy treatments, primarily. These treatments demonstrate efficacy in improving principally the qualitative components of pathological exercise (decrease of compulsion towards exercise, dysfunctional attitude towards exercise, rigidity towards exercise, exercise to regulate emotions and lack of pleasure during exercise and rule-based exercise) in addition to a favorable effect on other symptoms associated with eating disorder (increase of the body mass index, quality of life, motivational change stage and emotional acceptance as well as decrease of the global eating disorder severity, drive for thinness, perfectionism, depression symptoms and psychological distress). Treatments aimed at reducing pathological exercise should include adapted physical exercise combined with cognitive-behavioral therapy principles, principally. Also, pathological physical exercise treatment should (1) promote the benefit of group and pleasure to avoid ascetic and compulsive behaviors as well as provide a variety of movement, (2) include relaxation/rest intervals to reconnect with bodily sensations, (3) include psychoeducational interventions to learn to identify pathological physical exercise and (4) address emotions and cognitions related to exercise to change the function of behavior. Pharmacological treatments should be used only in specific cases and with great caution. While this review points to a predominantly uni- or multi-disciplinary approach to the management of pathological physical exercise, the multidimensionality and complexity of this phenomenon dictates that it be managed holistically through a transdisciplinary team. In this regard, transdisciplinary programs that consider physical exercise as a complex phenomenon transcending sectors of activity must be seriously considered. [ABSTRACT FROM AUTHOR]

Le « développement personnel » renvoie à un ensemble hétéroclite de savoirs syncrétiques, délivrés sous forme de livres, de vidéos ou de formations. Ces contenus sont recherchés par de nombreuses personnes dont l'objectif manifeste est la quête d'un soi authentique, dans une société où vacillent les étayages identitaires. Au-delà d'une considération critique, notre étude vise à mieux comprendre les motivations de ceux qui investissent ces savoirs et dispositifs non conventionnels. Au sein d'une revue de littérature sous forme d'anthropologie clinique, trois vignettes cliniques sont présentées à partir d'entretiens de recherche. L'un des participants est dans une pratique articulée autour de deux mentors ; un autre poursuit uniquement une réflexion nourrie par ses lectures ; et le dernier combine ses lectures à la consultation d'une psychologue. Tous poursuivent un désir de transformation intérieure en lien avec un questionnement identitaire. La lecture de tels ouvrages peut favoriser des formes de symbolisation médiatisée par la lecture. L'identification à des mentors constitue un étayage comparable aux préceptes religieux. Selon la perspective des participants à l'étude, le développement personnel stimule un travail auto-thérapeutique dont les limites sont dépassées par une ouverture progressive vers un autre, selon un processus de pré-engagement thérapeutique. S'il est possible de localiser les coordonnées de l'engouement actuel pour le développement personnel dans certaines mutations du lien social, il paraît nécessaire de développer une approche attentive et rigoureuse de cette forme de pluralisme thérapeutique sollicitée par une portion de la population générale. "Self-help" refers to a heterogeneous collection of syncretic knowledge, delivered in the form of books, videos or training courses. This content is sought after by many people whose obvious objective is the quest for an authentic self, in a society where identity supports are wavering. In addition to being a critical consideration, our study aims to better understand the motivations of those who invest in this knowledge and who feed their preferences for these non-conventional approaches. Within the framework of a literature review in the form of clinical anthropology, three clinical vignettes are presented, based on clinical research interviews conducted with volunteers engaged in a personal development process. One of the participants is involved in a practice that includes two mentors; another pursues only a reflective approach nourished by his readings; and the last one supplements his readings with psychological consultations. All of them pursue a desire for inner transformation in connection with a questioning of identity. Reading such works can promote forms of symbolization mediated by reading. The first vignette provides a clinical illustration of the concept of "apérité" developed by Nicolas Marquis. It demonstrates that the possibility for the subject to identify himself with the contents of the self-help book, which allows him to develop new representations, linked to his personal life history, thereby helping him to move towards a clearer representation of his internal world and the functioning of his identity. The second subject is more motivated by the hope of the existence of an ideal of life that he could implement with the help of the concrete application of certain key factors. He is trying to rebound from a complex family situation that has pushed him to break with his family. By adopting a self-help approach, he is attempting to find the support and backing that he did not have in his family environment. The identification with mentors constitutes a support comparable to a religious precept. The practice of mentoring embodies a real system of reference and support in the life of the third subject interviewed. Over time, this practice enabled him to establish a new relationship with his parents and to gradually emancipate himself. The mentor is often assigned to accompany the individual in the development of a mindset that favors his or her empowerment. This practice also underpins a path towards self-awareness, by inviting the subject to consciously reconnect with his internal world and the different sensations that run through it at various moments of daily life. From the perspective of the participants in the study, personal development stimulates a self-therapeutic work whose limits are exceeded by a gradual openness towards another, in a process of therapeutic pre-commitment. If it is possible to locate the coordinates of the current tendency to strive for personal development in certain mutations of the social bond, it seems necessary to develop a careful and rigorous approach to this form of therapeutic pluralism sought out by a portion of the general population. [ABSTRACT FROM AUTHOR]

Cet article propose de passer en revue les changements récents dans les méthodes d'intervention précoce des jeunes enfants avec Trouble du Spectre de l'Autisme. Nous sommes passés de modèles d'interventions intensives, en situations écologiquement non pertinentes, centrées sur les comportements autistiques des enfants, à des interventions moins intensives, au sein de la dyade, en contexte écologique. Elles ciblent l'interaction parent/enfant, notamment la synchronie, la sensibilité parentale, les compétences langagières et la communication sociale de l'enfant. Les différentes techniques de vidéo feed-back, particulièrement pertinentes chez l'enfant autiste, sont détaillées, notamment la VIPP, le PACT et la Thérapie de Guidance Interactive (TGI) avec leur intérêt, leur validité et leurs limites. L'enjeu est de développer ces techniques de manière reproductible et mesurable, tout en respectant la spécificité de chaque dyade. Nous proposons, pour répondre à ces gageures, de développer la TGI, qui répond aux exigences énoncées, et de développer la méthodologie du cas unique afin d'évaluer les effets des interventions précoces chez les enfants avec autisme. This paper aims to review recent changes in the methods of early intervention used in treating young children with Autism Spectrum Disorder. We have transitioned from models of intensive interventions, in ecologically irrelevant situations, that focus on children's autistic behavior, to less intensive dyad-based interventions in ecological contexts. They target parent/child interaction, including synchrony, parental sensitivity, language skills, and the child's social communication. The various video feedback techniques, particularly relevant for autistic children, are detailed, in particular VIPP, PACT, and Interactive Guidance Therapy (IGT) taking into account their interest, validity and limitations. The challenge is to develop these techniques in a reproducible and measurable way, while respecting the specificity of each dyad. To meet these challenges, we propose to develop the IGT model, which meets the stated requirements, and to develop the single-case methodology in order to assess the effects of early interventions on children with autism. [ABSTRACT FROM AUTHOR]

Cette étude longitudinale porte sur le développement de la communication chez des enfants de 3 à 6 ans avec TSA, scolarisés en unité d'enseignement en maternelle. Elle s'appuie sur l'observation directe de situations filmées en classe, soumises à une micro-analyse de la communication et des interactions sociales à l'aide d'une grille structurée. La fréquence et la qualité fonctionnelle des échanges sont comparées dans les interactions avec les adultes et avec leurs pairs, en situation structurée (travail à table) et en situation non structurée (jeu libre), et dans leur évolution au cours du temps (première année vs dernière année de maternelle). Les résultats montrent que l'engagement socio-communicatif des enfants est généralement plus fréquent dans les activités structurées et avec les adultes, essentiellement en modes de réponses aux sollicitations. Cependant, les initiatives des enfants augmentent dans le temps en situation de jeu libre. Les interactions à but instrumental demeurent la majorité des actes communicatifs. Les buts de partage social sont davantage favorisés par la situation de jeu, où leur proportion augmente au cours du temps. La part des intentions de partage d'états mentaux évolue peu au cours des trois années. Les trajectoires individuelles de progression diffèrent selon les caractéristiques des enfants. Ceux qui présentent les scores les plus avancés dans les échelles développementales au début de la scolarisation montrent une progression plus importante des interactions sociales et de la communication en classe. Les données sont discutées afin d'optimiser les dispositifs scolaires inclusifs. Inclusive preschool classrooms have been recently created (since 2014) in France for children with Autism Spectrum Disorder, giving them access to regular schools while adjusting to their specific needs. In these preschool small units, educative and mental health staff work together to support children's communicative and learning skills in order to help them to progressively attend regular classes in the same school. International research has reported the benefits of inclusive education on children with ASD, but studies mainly concerned children in full inclusion in regular classrooms, whose constraints, even with adapted programs, may not be suitable for all of them, especially young children. Moreover, studies conducted in specialized as well as in regular classrooms showed that the frequency and functional quality of the children's communicative exchanges may greatly vary, depending on the interlocutor and on the requirements of school situations (structured or unstructured). In this paper, we present a longitudinal study about communication development from age three to six in children with ASD attending an inclusive preschool program. On the basis of direct observations of situations filmed in class, variations of social communication were systematically examined as a function of partners (adults vs. peers), degree of structuration (work vs. free play), and over time. Participants were seven children with ASD, aged 3 at the beginning of the study and attending the same preschool inclusive unit. They were regularly videotaped (twice a year during three years) in two types of classroom situations: structured (working) and unstructured (free play), interacting with adults and peers. Data reported here are for the comparison between the first and the last collection point (three years vs. six years). Videos were coded using a structured microanalysis grid to capture the quality (forms and functions) of social and communicative behaviors of children and of their partners. In parallel, standardized evaluations were conducted on children's clinical and developmental characteristics. Data analysis showed a differentiated progression in quantity and quality of communication observed in preschool inclusive classrooms according to contextual parameters. Children's social-communicative engagement was generally more frequent in structured than unstructured activities, but initiations progressed over time in unstructured activities. Children interacted much more often with adults than with peers, with no significant increase in this gap over the years. The quality of children's communication improved both in forms and functions, but to varying degrees depending on the context. During structured activities, children became more able to use multimodal coordination (e.g., verbal/nonverbal) within the same communicative act while during unstructured activities they more often use one modality communicative acts. Concerning the purpose of interactions, children most often communicate for instrumental purposes than for social sharing purposes, a difference that persisted over time. A single subject analysis revealed important variations in pace and extent of developmental change between three and six years, with an increased progression observed in children with initial higher social and cognitive developmental levels. Findings are discussed in the perspective of optimizing the implementation of inclusive preschool educative settings for children with ASD. In particular, three points seem to deserve reinforced support: (a) to promote opportunities for children's initiatives in addition to soliciting responses; (b) to enhance the opportunities for social sharing; (c) to support peer-to-peer interactions during play or work co-activities. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic, which is a global health emergency, has potentiality had a serious impact on students' mental health. An online cross-sectional survey design that included 534 senior year college students from South India revealed a significant and direct positive effect of the fear of a third wave of COVID-19 on academic anxiety which in turn showed a significant and direct positive effect on COVID-19 burnout. Academic anxiety was also found to mediate the relationship between the fear of a third wave of COVID-19 and subsequent cases of burnout. The study suggested measures to be taken by policy makers for the broader interest and wellbeing of student communities. Managerial implications, limitations and future studies were also examined in the paper. [ABSTRACT FROM AUTHOR]

Cet article se penche sur les différentes conceptualisations et opérationnalisations de la compassion (pour soi et pour les autres), incluant les instruments de mesure et il souligne la nécessité d'élaborer une définition consensuelle de la compassion. À la lumière des appuis théoriques et empiriques actuelles, cet article soutient que la compassion implique des processus d'ordre affectif, cognitif, comportemental et interpersonnel. Dans des articles précédents publiés aux Annales Médico-Psychologiques (Khoury, Dionne, et Grégoire, 2019 ; Khoury, Grégoire, et Dionne, 2020), nous avons conceptualisé la pleine conscience comme étant à la fois « incarnée » et « interpersonnelle ». Prenant appui sur des études neurologiques et neurophysiologiques, cet article étend à la compassion ces deux dimensions essentielles qui sont également propres à la pleine conscience. Cette nouvelle façon de concevoir la compassion ouvre sur des perspectives nouvelles en recherche, notamment dans l'évaluation et la mesure de la compassion et a des implications dans le domaine des approches axées sur la compassion pour soi. The aim of this paper is to review current conceptualizations, assessment measures, and operationalizations of compassion (towards self and others) in order to propose a new theoretically grounded, empirically driven, unified notion of compassion towards self and others. In previous papers published in the Annales Médico-Psychologiques (Khoury, Dionne, & Grégoire, 2019; Khoury, Grégoire, & Dionne, 2020), we conceptualized mindfulness as being both "embodied" and "embedded" in the interpersonal and social context. Drawing on psychological, neurological, and neurophysiological evidence, this article extends these two essential dimensions (embodied and embedded/interpersonal) to compassion for self and others. In order to investigate the current conceptualizations, measurements, operationalizations of compassion towards self and others, we conducted a thorough qualitative review of theoretical and empirical papers pertaining to compassion from both Eastern Buddhist traditions and Western-based approaches. We put a particular emphasis on neurological and neurophysiological evidence. Different Buddhist and Western conceptualizations of compassion towards self and others are presented, critically reviewed, compared, and discussed and common affective, cognitive, behavioral, and interpersonal components are drawn from these diverse conceptualizations. In addition, assessment measures of compassion towards self and others are presented along with their psychometric qualities and limitations. Multiple compassion-based interventions and programs are also presented and discussed. The role of the body in compassion towards self and others and more specifically the bidirectional mind-body connection is highlighted through the analysis of clinical, behavioral, and neuroscientific research findings. Empirical findings supporting the embodiment of compassion are thoroughly presented and linked to the proposed conceptualization of compassion towards self and others. Finally, we discuss the implications of the new conceptualization of compassion towards self and others as well as the limitations of this conceptualization and future research directions. Theoretical and empirical findings suggest that compassion has both top-down (cognitive) and bottom-up (emotional, somatosensory) dimensions and more precisely can be an integration (convergence) of both dimensions. In addition, the physical body seems to be central in the etiology, development, and expression of compassion. Moreover, neurophysiological evidence suggests that compassion can be behaviorally reinforced. Taken together, this suggests that compassion can be viewed as embodied and can be operationalized as a cognitive, emotional, and behavioral skill/ability that involves both self and others, therefore is embedded in the interpersonal/social context. Similar to mindfulness, compassion can therefore, be considered and integrated state of mind involving emotional, cognitive, and behavioral components. Mindfulness and compassion might also share neurophysiological commonalities, through the integration of top-down and bottom-up processes and the activation of specific vagal pathways as was proposed by the Polyvagal Theory. However, more research is warranted to delineate commonalities and differences between these two contemplative practices. The new notion of embodied and embedded compassion integrates different conceptualizations of compassion by grounding compassion in common affective, cognitive, behavioral, and interpersonal processes across different conceptualizations. This notion has important implications in conceptualizing and measuring compassion and in devising and validating new compassion-based interventions. Therefore, this notion should be taken in consideration in conducting future research on compassion towards self and others. [ABSTRACT FROM AUTHOR]

Climate change and global warming have led to an increased incidence of flooding across the world. Against the backdrop of the recent devastating floods in the Kwazulu-Natal province of South Africa, this paper explores psychotraumatology of natural disasters. In particular, we explore the impact of internal migration in South Africa, as well as apartheid spatial planning and inequality on the consequences of the flooding. We also focus on the psychotraumatology resulting from flooding, in general, and in particular on the victims of the flooding in the KwaZulu-Natal province of South Africa. We conclude that the psychopathological consequences of such natural disasters are ignored even though they seriously affect the people concerned. The development of specific trainings for psychologists in psychotraumatology and the care of victims should be a priority in the future. [ABSTRACT FROM AUTHOR]

En janvier 1940, le premier bulletin de l'année de la revue Annales Médico-psychologiques (Ann Med Psychol 1940 ; 98) [11] , publie le compte rendu de la séance du 2 décembre 1939 de la Société Médico-Psychologique, et notamment une communication du Docteur Gaston Ferdière, sur un cas de lobotomie (« Résultats immédiats de la leucotomie préfrontale dans un cas de stupeur catatonique », p. 111-119), intervention réalisée à l'hôpital d'Issoudun (sous-préfecture du département de l'Indre, 36) le 2 décembre 1939, et rapporte aussi la vive discussion qui suivit, avec, en particulier, les critiques du Professeur Henri Baruk. C'est la première communication relative à l'utilisation de cette technique en France, et si, aujourd'hui, son intérêt scientifique et thérapeutique n'est plus qu'historique, cette méthode de leucotomie, pourtant considérée à l'époque comme novatrice, ayant été abandonnée, la communication pose des questions éthiques qui restent très actuelles. Après avoir résumé la communication et la discussion, et décrit, pour mémoire, la méthode, nous évoquerons ces questionnements, puis la personne même de l'auteur de la communication : le Dr Gaston Ferdière, qui reste connu pour avoir été le psychiatre d'Antonin Artaud, et dont la carrière professionnelle, et l'image qu'il a laissée, paradoxales, sont en soi une véritable tragédie éthique. In January 1940, the first bulletin of the year of the journal «Annales Médico-Psychologiques» (Ann. Med.-Psych., 15th series, 98th year, T.I, January 1940, 522 p.) [11] , published the report of the session of December 2, 1939 of the Société Médico-Psychologique, and in particular a communication by Doctor Gaston Ferdière, on a case of lobotomy (immediate results of prefrontal leucotomy in a case of catatonic stupor, pp 111-119), intervention performed at the hospital of Issoudun (Sub-prefecture of the department of Indre; 36) on December 2, 1939, and also reports the lively discussion that followed, with, in particular, the criticisms of Professor Henri Baruk. This is the first communication relating to the use of this technique in France, and if today its scientific and therapeutic interest is only historical, this method of leucotomy, however considered at the time as innovative, having been deleted, these paper poses ethical questions that remain very topical. After having summarized the communication and the discussion, and described, for the record, the method, we will evoke these questions, then the author's life of the paper: Doctor Gaston Ferdière, who remains known for having been the psychiatrist of Antonin Artaud, and whose professional career, and the image he left, paradoxical, are in themselves a true ethical tragedy. [ABSTRACT FROM AUTHOR]

La spiritualité et la religion sont des domaines importants de la vie humaine qui suscitent l'intérêt des chercheurs en psychologie et en médecine à propos de leurs possibles effets sur la santé mentale. Depuis près de quarante ans, un nombre croissant de recherches ont montré les effets positifs du couple spiritualité/religion sur la santé mentale par l'intermédiaire de différents processus comme le coping, l'optimisation du lien social, le pouvoir des croyances et les bienfaits de certaines approches thérapeutiques utilisant la spiritualité. Cependant, au niveau des thérapies complémentaires et alternatives qui utilisent la spiritualité comme vecteur de soins ou qui s'inscrivent dans le champ de la spiritualité, on retrouve beaucoup de recherches qui se caractérisent par des biais méthodologiques importants ne permettant pas de valider la pertinence et l'efficacité systématique de ces thérapies. De ce fait, cette recherche a pour objectif d'étudier l'impact des approches thérapeutiques basées sur la spiritualité, sur la santé mentale au niveau de l'anxiété en suivant une démarche méthodologique rigoureuse de sélection des travaux de recherche. Nous avons effectué une revue de la littérature sur le sujet, de recherches contrôlées et randomisées. Quinze recherches ont été sélectionnées et ont montré des effets positifs des approches psycho-spirituelles sur la santé mentale, qu'il convient toutefois de nuancer en raison de limites méthodologiques importantes qui seront développées. Les approches de types TCC (Thérapies Comportementales et Cognitives) ayant la spiritualité comme thématique de base ressortent nettement de cette étude. Cela souligne la pertinence d'utilisation de la spiritualité dans une optique comportementale et cognitive dans le traitement de la relation entretenue avec les pensées et les émotions dans une optique de changements adaptatifs et de style de vie permettant une meilleure gestion de l'anxiété. La dimension de la spiritualité est riche en perspective d'accompagnement thérapeutique et les approches cognitives et comportementales de la 3e vague des TCC travaillant sur les relations entretenues avec les cognitions, les valeurs de vie et les émotions sont une piste sérieuse à exploiter dans le cadre de traitements psychothérapeutiques complémentaires pour le soin de l'anxiété. Spirituality and religion are important areas of human life that have aroused the interest of researchers in psychology and medicine with respect to their potential effects on mental health. A growing body of research for nearly 40 years has demonstrated the positive effects of spirituality/religion on mental health through different processes such as coping, optimization of social bonding, the power of beliefs, and the benefits of certain therapeutic approaches using spirituality. However, at the level of complementary and alternative therapies which use spirituality as a vector of care or which fall within the field of spirituality, we find considerable research which is characterized by significant methodological biases that do not allow us to validate the relevance and the systematic effectiveness of these approaches. Therefore, the objective of this study is to examine the effectiveness of therapeutic approaches based on spirituality in treating anxiety. We carried out a review of the literature on the subject that used randomized controlled trials. Fifteen studies that demonstrated positive effects of psycho-spiritual approaches on mental health were selected. These studies should, however, be put into perspective because of significant methodological limitations. Cognitive Based Therapies (CBT)-type approaches with spirituality as a basic theme clearly stand out from this study and underline the relevance of using spirituality from a behavioral and cognitive perspective in the treatment of the relationship maintained with thoughts and emotions in a context of adaptive and lifestyle changes, allowing for better management of the pathologies studied. The dimension of spirituality is rich with respect to therapeutic support, and the cognitive and behavioral approaches of the 3rd wave of CBT relying on the relationships maintained with cognition, life values and emotions are a serious avenue to be exploited within the framework of complementary psychotherapeutic treatments for anxiety. [ABSTRACT FROM AUTHOR]

La visée de cette recherche est de mieux comprendre le vécu psychique de l'Insuffisance Ovarienne Précoce (IOP) chez une jeune femme qui souhaite s'engager avec son compagnon dans une grossesse. Après avoir rappelé l'impact de cet événement somatique sur la psychosexualité féminine mais aussi le sentiment d'incomplétude lorsque l'infertilité survient, nous avons présenté un dispositif méthodologique basé sur des entretiens cliniques de recherche, des épreuves projectives (Rorschach, TAT) et un génogramme imaginaire pour analyser comment la participante élabore ses liens filiatifs et affiliatifs depuis l'annonce du diagnostic d'IOP. L'analyse des données cliniques et projectives dans un référentiel métapsychologique a mis en évidence des défenses narcissiques (idéalisation du couple), des marques de retrait relationnel, une élaboration complexe des identifications et notamment de la polarité féminine. Les imagos parentales se sont avérées insuffisantes à soutenir le narcissisme de la participante et donc à déployer les identifications. Quant au génogramme imaginaire, il illustre un fantasme incestuel et une dissociation du conjugal et du parental. Si la maternité pourrait être envisagée comme une sortie de la relation fusionnelle à la mère et soutenir une identité féminine, l'IOP, paradoxalement, maintiendrait la participante comme une éternelle enfant et ferait l'économie de la rivalité adressée à la mère (seule génitrice). The aim of this research is to better understand the psychological experience of premature ovarian failure (POF) in a young woman who desires to become pregnant with her partner. After taking into consideration the impact of this somatic event on female psychosexuality and the feeling of inadequacy in cases of infertility, we present a methodological approach based on clinical research interviews, projective tests (Rorschach, TAT), and an imaginary genogram to analyze how the participant approaches her filial and affiliative links following the announcement of the diagnosis of POF. The research was spread out over almost a month and used the following procedure: first of all, we conducted an initial interview concerning the impact of the announcement of the POF. During a second interview, the instructions were to go back over the salient elements of her life story (relationship with her parents, love life, desire for a child, etc.). Following this interview, the Rorschach and the TAT were administered. A session was devoted to doing the genograms, and finally a last meeting recorded her return on the research. Only the projective tests were carried out in the same session. The analysis of the clinical and projective data in a metapsychological perspective revealed narcissistic defense mechanisms (the idealization of the couple), indications of relational withdrawal, and a complex elaboration of identifications, particularly regarding feminine polarity. The parental imagos proved to be insufficient to support the participant's narcissism and to enforce the identifications. Moreover, the imaginary genogram illustrates an incestual fantasy and a dissociation of the conjugal being from the parental being. If motherhood could be envisaged as a way out of the fusional relationship with the mother and support a feminine identity, it seems that the ovarian failure, paradoxically, would relegate the participant to the status of an eternal child and would avoid the feelings of rivalry toward the mother (who remains the sole genitor). The fact that the partner was not involved in the data collection is one of the limitations of this research and it would seem interesting to include input from the partners in our future. [ABSTRACT FROM AUTHOR]

Les lacunes des classifications de la psychopathologie fondées sur des consensus d'experts ont conduit à de nombreuses tentatives actuelles pour classer la psychopathologie de manière quantitative. Dans cet article, nous passons en revue les progrès accomplis dans la réalisation d'une classification quantitative et empirique de la psychopathologie. Une littérature empirique substantielle montre que la psychopathologie est généralement plus dimensionnelle que catégorielle. Et lorsque la distinction entre une psychopathologie discrète et une psychopathologie continue est traitée comme une question de recherche, par opposition à une distinction basée sur un argument d'autorité, alors les preuves scientifiques soutiennent clairement l'hypothèse d'une psychopathologie continue. En outre, un corpus de littérature connexe montre comment les dimensions de la psychopathologie peuvent être organisées selon une hiérarchie qui va de dimensions très larges d'un niveau de type « spectre » à des groupes spécifiques et étroits de symptômes. De cette manière, une approche quantitative résout le « problème de la comorbidité » en modélisant explicitement la cooccurrence entre les signes et les symptômes au sein d'une hiérarchie détaillée et variée, maniant des concepts dimensionnels qui ont une utilité clinique directe. De nombreuses preuves concernant la structure dimensionnelle et hiérarchique de la psychopathologie ont conduit à la formation du consortium Hierarchical Taxonomy of Psychopathology (HiTOP, taxonomie hiérarchique de la psychopathologie). Il s'agit d'un groupe de 70 chercheurs travaillant ensemble pour étudier la classification empirique de la psychopathologie. Dans cet article, nous décrivons les objectifs et les axes de recherches actuels du consortium HiTOP. Ces objectifs concernent la poursuite des recherches sur l'organisation empirique de la psychopathologie ; le lien entre la personnalité et la psychopathologie ; l'utilité des construits empiriques de la psychopathologie, à la fois pour la recherche et pour la clinique ; et enfin, le développement de nouveaux modèles exhaustifs et d'instruments d'évaluation correspondant aux construits psychopathologiques dérivés d'une approche empirique. Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level" dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity" by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach. [ABSTRACT FROM AUTHOR]

Suite à un agir d'homicide sur leurs enfants, nous avons rencontré trois femmes hospitalisées pour préserver la répétition d'un acte d'autolyse. Comme nombre de parents dans notre contexte sociétal, elles se sont reconnues dans la notion de « parentalité bienveillante ». Ces passages à l'acte interviennent suite à une annonce similaire, celle qui renvoie à l'enfant cassé. Nous proposons ici une lecture psychocriminologique de l'agir filicide dans un contexte de parentalité bienveillante à partir du concept du double. This paper describes three women who, following acts of filicide and attempted suicide, had been hospitalized to reduce suicidal risk while in detention. À similar event preceded all three homicidal acts: the implementation of an additional medical, educational or paramedical support, or the failure to do so. We questioned their parenting in relation to social discourse around positive parenting. These women described having imagined an "ideal child" which was free of poor transmission and who would restore them in return. In an environment where separation from their romantic conjugal partners was not an option, the women viewed their child as "broken" and resorted to action. This led us to the hypothesis that the mother-child relationship referred to the concept of double; this latter was first reflexive and supporting but disrupted the maternal psyche and its unrecognized obscure zone with the announcement of the child being « broken ». [ABSTRACT FROM AUTHOR]

This paper presents the validation and inter-rater reliability study of the French translation of the new edition of the SCID-D, a semi-structured clinical interview for evaluating dissociative symptoms and diagnosing dissociative disorders based upon DSM-5 and ICD-11 criteria. The SCID-D evaluates five core dimensions of dissociation: amnesia, depersonalization, derealization, identity confusion and identity alteration. The SCID-D was administered to 20 subjects with a dissociative disorder, 19 subjects with a nondissociative psychiatric disorder, and 10 healthy control subjects. Results indicate that there was 96% agreement among raters on the SCID-D's ability to differentiate subjects with a dissociative disorder from subject with no dissociative disorder. The statistical analysis indicates that the overall diagnosis, the scores for each of the five dimensions, and the total SCID-D scores were homogenous amongst raters. The results indicate good to excellent inter-rater reliability. The SCID-D could efficiently discriminate dissociative subjects from nondissociative ones. Convergent validity was tested with the use of the Somatoform Dissociation Questionnaire SDQ-20 and the Dissociation Questionnaire DIS-Q. Correlation between the scores from these questionnaires and the SCID-D total score is high. The French translation of the SCID-D has good to excellent reliability, discriminant and convergent validity, and is similar to previous research of DSM-III and DSM-IV versions of the SCID-D in different languages. The SCID-D is a useful instrument for the assessment of dissociative symptom severity and the diagnosis of DSM-5 and ICD-11 dissociative disorders. [ABSTRACT FROM AUTHOR]

Les stratégies de coping modèrent la relation entre les situations stressantes et les issues de santé. Une question se pose quant à la capacité des individus à alterner entre différentes stratégies. Cette capacité fait référence au processus de flexibilité du coping , qui est considéré comme une capacité méta-cognitive. Cette conceptualisation de la flexibilité du coping nécessite la mise à disposition d'outils permettant de la mesurer. L'objectif des deux études présentées ici était d'examiner les propriétés psychométriques de l'échelle de flexibilité du coping (CFS) en population générale adulte française. La CFS est un questionnaire d'auto-évaluation permettant d'apprécier les dimensions d'évaluation et d'adaptation de la flexibilité du coping. La structure factorielle, la fiabilité ainsi que la validité de la CFS ont été évaluées à travers deux échantillons. Une analyse factorielle exploratoire conduite sur les données du premier échantillon a conduit à retirer trois des dix items originaux de la CFS en raison de faibles saturations observées. Une analyse factorielle confirmatoire a mis en évidence une structure à deux facteurs pour la CFS à 7 items. Cette nouvelle échelle réduite a démontré par ailleurs des validités de critère et de construit satisfaisantes. Le second échantillon a permis de confirmer ces résultats, en particulier la structure à deux facteurs de la CFS. Dans l'ensemble, les résultats obtenus sur les deux échantillons conduisent à considérer la CFS à 7 items comme un outil permettant de mesurer les dimensions d'évaluation et d'adaptation de la flexibilité du coping. Coping strategies moderate the relationship between a stressful situation and health outcomes. A question arises as to the ability of individuals to alternate between different strategies. This capacity refers to the process of coping flexibility which could be defined as the individuals' ability to effectively modify coping behavior according to the specific nature of stressful situations. Among the different theoretical frameworks of coping flexibility, the dual-process theory considers that coping flexibility is a meta-cognitive ability, which comprises two reciprocal processes: evaluation coping and adaptive coping. In order to measure these two processes, the Coping Flexibility Scale (CFS) has been developed. The objective of the two studies reported in this paper was to examine the stability of the psychometric properties of the CFS in French adult population, because there is no validated French scale to assess coping flexibility and because existing validated French-language scales are primarily dedicated to assess the extent to which individuals are variable in their use of coping strategies but not in how they are flexible in such use. The CFS is a self-report questionnaire for assessing the two dimensions of coping flexibility, namely evaluation and adaptive coping. Two studies were conducted to test the two-factor structure, reliability and validity of the CFS in several samples. In both studies, coping flexibility was measured with the CFS; coping strategies with the Brief COPE inventory and two indexes of stress adaptation were measured using the Perceived Stress Scale, and the Satisfaction with Life Scale. In Study 1, extremely poor factor loading led to remove three of the 10 original items. A confirmatory factor analysis evidenced a two-factor structure for the 7-item CFS, which also demonstrate satisfactory construct and criterion validity. The Study 2 replicated the results obtained in Study 1, especially the two-factor structure of the CFS. Overall, the results obtained in the two validation studies of the CFS reveal a satisfactory stability of the factorial structure of the scale in its 7-item version. The 7-item French CFS appears as a questionnaire that can capture the two dimensions of coping flexibility defined as a meta-cognitive ability. [ABSTRACT FROM AUTHOR]

La psychiatrie actuelle reconnaît les « dyskinésies spontanées » comme des manifestations possibles de la schizophrénie. Nous pensons qu'il ne s'agit que d'un nouveau nom donné à des mouvements anormaux intrinsèques aux psychoses endogènes décrits depuis plus d'un siècle sous le nom de « parakinésies ». Celles-ci ont été décrites, filmées et leur intérêt pronostique a été décrit bien avant l'ère des neuroleptiques. Enfin, il est le plus souvent possible de les différencier des dyskinésies tardives. Malheureusement, les parakinésies sont restées absentes de la littérature internationale, un manque qu'il nous a semblé opportun de combler. La distinction entre les parakinésies de type « dyskinésies psychomotrices », d'une part, et la psychomotricité parakinétique (PMP), d'autre part, n'est qu'un artifice didactique, étranger au concept originel de parakinésies. Les parakinésies ont l'aspect de gestes expressifs ou réactifs déformés survenant de façon inappropriée. Elles sont parfois reconnues comme un grimacing , mais sont souvent prises pour des dyskinésies tardives. La PMP correspond à la perte de la grâce naturelle des mimiques et de la gestuelle qui deviennent dysharmonieuses, bizarres, parfois identifiées comme un maniérisme catatonique. Parakinésies et PMP ne sont pas identifiées par les patients, même si on attire leur attention dessus, et ne les gênent jamais. Elles s'accroissent le plus souvent avec le temps. Les parakinésies sont atténuées, voire disparaissent, sous antipsychotiques de forte affinité. En dehors de leur intérêt clinique et pronostique, les parakinésies proposent un éclairage original et inspirant pour la recherche. Abnormal movements are long known to be intrinsic to some forms of endogenous psychoses. Spontaneous dyskinesia are the ones observed by naïve first episode patients and at-risk subjects. Yet, these are only the rediscovery of more complex phenomena denoted as "parakinesias", which had been described and documented by extensive kinetographic recordings and long-term observations decades before the introduction of neuroleptics. Unfortunately, they were largely neglected by mainstream psychiatry to the point of privation in the French and English literature. Renewed interest in psychomotor phenomena deems it timely to remind the neuropsychiatric community about that concept. Parakinesias consist of various deformations of psychomotor sequences which, for descriptive purpose, can be separated into parakinesias, i.e. abnormal, dyskinetic-like movements, and parakinetic psychomotricity (PPM). Parakinesias are a form of hyperkinetic movement disorder that is quite specific to endogenous psychoses. Parakinesias can be described as pseudo-reactive and pseudo-expressive motions, i.e. they resemble psychomotor gestures that are not only occurring inappropriately, but that are also somewhat distorted. These deformities do not only affect parakinesias but also the individual style of psychomotor outputs resulting in PPM. Gestures and mimics lose their naturalness and become awkward, disharmonious, stiff, mannered, and bizarre. Parakinetic distortions increase over time, so that parakinesias lose their expressiveness and have a more choreiform appearance. They also become more uniform and stereotyped. PK are prevailing in the upper face and the axial and proximal musculature of the upper body. They are not experienced as self-dystonic or alien by the patients, who are not aware of them, even when their attention is drawn to them. Finally, PK are more frequent and manifest as the level of psychomotor excitement is increased whereas they are attenuated up to disappear under high affinity antipsychotics. In non-naive patients, parakinesias might be mistaken for tardive dyskinesia. When they resemble distorted facial expressions, they fit with the concept of "grimacing" whereas PPM is partly captured by the concept of "mannerism". The goal of this paper is to enhance recognition of parakinesias beyond grimacing and spontaneous dyskinesias. They deserve to be known by clinicians, especially for their prognostic value. From a general perspective, parakinesias and PPM allow to formulate new hypotheses of psychomotor phenomena that ought to be debated, investigated, and tested. [ABSTRACT FROM AUTHOR]

Le concept d'injustice épistémique s'intéresse à la manière dont la capacité d'un sujet à produire du savoir peut être déniée ou minorée. Nous nous proposons ici d'étudier son intérêt en psychiatrie, de la pratique clinique à la nosographie. Après avoir défini les principales injustices épistémiques, nous étudions leur application à la relation médecin-malade. Nous cherchons enfin à comprendre quel pourrait être l'apport de ce concept dans la clinique psychiatrique mais aussi dans la classification des troubles mentaux. Les patients souffrant de troubles mentaux sont particulièrement vulnérables aux injustices épistémiques. Des facteurs prédisposants peuvent être identifiés, certains communs à tous les troubles psychiatriques, d'autres spécifiques à chaque pathologie. Les classifications en psychiatrie reflètent aussi l'existence d'un déséquilibre épistémique entre usagers et communauté scientifique. L'inclusion des usagers dans l'élaboration de la nosographie est de plus en plus consensuelle, car elle pourrait permettre d'améliorer leur validité, avec un impact sur la pratique clinique, sur les questions de stigmatisation ou encore le financement de la recherche. La notion d'injustice épistémique pourrait constituer un cadre conceptuel pour mettre en évidence les situations dans lesquels le discours du patient n'est pas suffisamment pris en compte alors qu'il constitue un savoir pertinent. Il nous semble donc utile dans une approche intégrative visant à mieux articuler savoirs médical et expérientiel, sous réserve du développement d'outils pour mieux recueillir ce savoir expérientiel. The concept of epistemic injustice was developed in 2007 by Miranda Fricker. It designates a specific category of prejudices, where the subject's capacity to produce knowledge is denied or undermined. Several authors have applied this concept to the field of health and argue that people with a medical condition are more vulnerable to epistemic injustices than healthy people. In psychiatry, some authors believe that patients are even more vulnerable to such injustices in clinical practice than patients of other specialties. Some others identify certain forms of epistemic injustice in the classifications of mental disorders, and postulate that it could lead to epistemic losses in classifications, diagnoses and care. In France, this concept is relatively unexplored in psychiatry. The aim of this paper is to identify and summarize the potential contributions of the concept in psychiatry, from the clinical practices to the definition of mental disorders. First, we will define the main types of epistemic injustice described by Fricker. We will then see how these injustices can occur in the field of health. Finally, we will study why patients with a mental disorder are particularly affected by these injustices, the potential impact on psychiatric nosography and the ways to address these epistemic injustices. There are two types of epistemic injustice. In testimonial injustices, a person's speech is unwittingly considered to be of little or no credibility by his interlocutor, because of negative prejudices against him or his community. Hermeneutic injustice occurs when a person fails to convey their experience, due to a lack of hermeneutical resources to interpret and communicate it. In healthcare, the credibility of the patient's testimony can be diminished by several factors and general prejudices. Additionally, there is a lack of interpretive resources to understand and share many aspects of the experience of illness. In addition to this, the epistemic privilege accorded to healthcare professionals, particularly physicians, leads to accentuating the epistemic imbalance. The type of doctor-patient relationship, and its evolution, also impact the respective epistemic positions. In psychiatry, patients are seen as more vulnerable to epistemic injustices. Crichton thus identifies three common factors to all mental disorders, including a general prejudice of irrationality and unreliability. In addition, each pathology has specific factors exposing patients to a weakening of their epistemic capacity. To correct these injustices, several tools have been proposed, such as including the study of epistemic injustice in physician's training or using a phenomenological toolbox. Anke Bueter also suggested the existence of a specific form of testimonial injustice in psychiatric classifications, known as "pre-emptive", which excludes the possibility for ill people and their relatives to testify. However, taking these testimonies into account could act as a corrective mean in the construction of nosography. This nosography is indeed based, in psychiatry, on value judgments, due to the lack of objective data. Several authors, including Bueter, therefore call for a better integration of users in the revisions of classifications, to improve their validity. This could have implications for the clinic, research and its funding, and other issues such as stigmatization. However, how exactly the users' point of view could be integrated still needs to be defined. Several proposals have been found in the literature. We consider that the concept of epistemic injustice is a useful tool towards a better articulation between experiential and medical knowledges. In clinical practice, if the clinician is trained in this concept, he will be able to identify situations at risk of epistemic injustice, attempt to neutralize this imbalance and thus carry out a more exhaustive clinical examination and more appropriate care for the patient. Regarding nosography, strengthening the epistemic position of users and integrating their knowledge could improve the validity of classifications. The question of the validity of psychiatric nosography is a problem that the scientific community has faced for a long time, and it therefore seems interesting to continue this reflection through the concept of Fricker. In both cases, it is necessary to continue developing tools to better define, analyze and integrate this experiential knowledge. [ABSTRACT FROM AUTHOR]

Les théories du complot, aujourd'hui très présentes dans l'espace public, sont très peu étudiées par la psychologie clinique — en partie par crainte d'une application abusive des catégories psychopathologiques. Nous questionnons ici la pertinence d'une approche clinique psychodynamique de ce phénomène. Les implications et la portée heuristique de trois notions cliniques sont discutées : paranoïa, perversion et traumatisme. Une conception psychodynamique questionne les théories du complot comme des constructions subjectives et collectives, en évitant le risque d'une qualification diagnostique des sujets qui y adhèrent, et d'une dichotomie entre normal et pathologique. Cet article ébauche une clinique différentielle de ce phénomène très vaste et hétérogène du conspirationnisme, particulièrement nécessaire pour penser ses principales dimensions et des modalités de prévention. Conspiracy theories appear today as a specific collective imaginary. Belief in conspiracy theories seems to have clearly increased during the last decades, partly due to their elaboration and diffusion via social media. A lot of empirical research about conspiracy theories are designed in social and cognitive psychology, but only a few studies adopt a clinical point of view. One reason is that such a clinical approach carries the risk of abusively applying some psychopathological notions to a wide range of the general population, and to a social – and not only individual – construct. This paper aims to promote a psychodynamic approach to conspiracy theories. We argue that this approach allows to studying them as subjective and collective constructs, leaving aside any attempt to make a diagnosis on people believing in conspiracy theories, and any dichotomy between the normal and the pathological. We discuss three clinical ways to represent the psychological functions of conspiracy theories: paranoid ideation, perverse uses, and reaction to traumatic events. As a matter of fact, these clinical notions are often explicitly referred to, or implicitly implied, when psychological motives or functions of belief in conspiracy theories are discussed. We seek to point out the implications of these three clinical notions and their ability to shed light on conspiracy theories. This leads to discuss their relevance for a differential clinic of the belief in conspiracy theories, allowing to identify the various dimensions of conspiracy theories, and of their subjective uses and functions. Through a psychodynamic understanding of clinical entities, conspiracy theories can be studied as both subjective and collective constructs. In this way, we argue that a psychodynamic approach can avoid the risk of a diagnostical and pathological use of clinical concepts stemming from a binary distribution between the normal and the pathological. It rather leads to question along a continuum the various dimensions of conspiracy theories and of the belief in their content. The phenomenon of conspiracy theories seems to emerge from a wide range of heterogeneous and distinctive constructs, uses and attitudes. Belief in conspiracy theories can provide several kinds of psychological benefits, implying various subjective functions and psychic mechanisms. Moreover, in terms of psychological attitudes, we have to clearly distinguish different phenomena: some spontaneous and collective elaborations of conspiracy theories, belief in conspiracy theories, the process of their diffusion, and their political, social and psychological intentional uses. These heterogeneous dimensions raise the risk of undermining any study of this phenomenon considering it as a unidimensional and a unified construct. In this way, we argue that a differential clinic of this conspiracy phenomenon is a methodological need, prior to the design of empirical clinical studies and to the reflection about preventive actions. [ABSTRACT FROM AUTHOR]

Le contexte géopolitique actuel, avec la multiplication des attentats sur le territoire national, a fait émerger une prise de conscience collective concernant la reconnaissance et la prise en charge des blessés psychiques. Ces événements psychotraumatiques sont en réalité bien plus larges et regroupent les catastrophes naturelles ou technologiques, mais aussi les catastrophes microsociales. Premier recours naturel dans la population, le médecin généraliste est en partie responsable de la prise en charge des pathologies psychotraumatiques. Cette étude dresse un état des lieux de ces prises en charge en médecine générale dans le Pas-de-Calais, en évaluant le repérage diagnostique en cabinet, le sentiment de compétence du professionnel, les thérapeutiques prescrites, l'orientation secondaire ainsi que les difficultés rencontrées en consultation. Au total,141 médecins généralistes exerçant dans le Pas-de-Calais en cabinet ont été inclus sans critères d'exclusion, par le biais d'auto-questionnaires en ligne ou papier. Les médecins généralistes semblent sous-estimer la fréquence des pathologies psychotraumatiques, mais constatent à 83,6 % une augmentation de cette dernière. 95,8 % admettent un probable impact sur leur pratique en cas de catastrophe. Malgré les recommandations de l'HAS, 73,8 % prescrivent des benzodiazépines pour 19,1 % d'antihistaminiques. Les options d'orientation secondaire spécialisées sont mal connues : 77,3 % ignorent l'existence des consultations du psychotraumatisme. La formation initiale semble insuffisante pour maîtriser ces compétences, 59,6 % recourent à des lectures personnelles et 29,8 % à la formation continue. Les principales difficultés pointées dans ces prises en charge consistaient en la durée de consultation, la gestion de la charge émotionnelle et options d'orientation secondaire. Ces résultats, associés aux souhaits exprimés par une grande majorité des généralistes, suggèrent l'intérêt d'une formation complémentaire. Si l'urgence médico-psychologique renforce actuellement son dispositif, il semble nécessaire d'adapter les compétences, les moyens et les options d'orientation secondaire des médecins généralistes. Interlocuteurs privilégiés d'une population souvent vierge de pathologie psychiatrique, il est indispensable d'inclure ces praticiens dans le réseau de soin du psychotraumatisme. The current geopolitical context, with the increase in the number of attacks on national territory, has brought out a collective awareness concerning the recognition and care of the psychologically injured. Traumatic events are in fact much broader and include not only natural or technological disasters, but also micro social disasters. As the first natural recourse in the population, the general practitioner is partly responsible for the management of psychotraumatic pathologies. This study provides an overview of the state of general medical care in the Pas-de-Calais: professional's sense of competence, the therapies prescribed, the secondary referrals and the difficulties encountered in consultation. A total of 141 general practitioners practising in the Pas-de-Calais in private practice were included without exclusion criteria, by means of online or paper self-questionnaires. GPs seem to underestimate the frequency of psychotraumatic pathologies, but 83.6% of GPs note their increasing prevalence and 95.8% admit a probable impact on their practice in the event of a disaster. Despite the HAS recommendations, 73.8% prescribe benzodiazepines and 19.1% antihistamines. Knowledge of specialised secondary referral options available is poor: 77.3% of GPs are unaware of the existence of Psychotrauma counselling. Initial training seems insufficient to master these skills, 59.6% use personal reading and 29.8% use in-service training. The main difficulties noted in these treatments were the length of consultation, the management of the emotional load and secondary referral options. These results, combined with the wishes expressed by a large majority of GPs, suggest the value of further training. If the medical-psychological emergency service is currently strengthening its system, it seems necessary to adapt the skills, resources and secondary referral options available to GPs. As privileged interlocutors of a population often devoid of psychiatric disorders, it is essential to include these practitioners in the Psychotrauma care. [ABSTRACT FROM AUTHOR]

Jean Garrabé a publié une quarantaine d'articles historiques dans les Annales Médico-Psychologiques (AMP). Il y a traité de l'histoire des classifications, de l'évolution de certains concepts cliniques (la dissociation, les troubles bipolaires), des grands courants de pensée de la psychiatrie du XXe siècle (psychopathologie, politique, mondialisation, antipsychiatrie), de ses relations avec la création artistique, littéraire et musicale. Mais il y a surtout rédigé de nombreuses notices biographiques de figures de la médecine mentale en France, qui s'échelonnent du début du XVIIe siècle (Montalto) à la fin du XXe (Ey, Lacan). Le personnage de Pinel apparaît à de nombreuses reprises dans ses articles comme une figure centrale de la discipline, traitée à la fois loin de l'hagiographie et de la remise en cause systématique. Jean Garrabé peut être considéré comme un « psychiatre-historien », à la fois érudit et critique. Jean Garrabé has published about 40 historical articles in the Annales Médico-Psychologiques. He has written on the history of the classifications, on the evolution of clinical entities (bipolar disorders) and of theoretical matters (psychopathology, politics, mondialization, antipsychiatry), on the relationships of psychiatry with artistic, literary and musical creation. But he has above all written many biographical notices of practitioners of mental medicine in France from the beginning of the 17th century (Montalto) to the end of the 20th (Ey, Lacan). The personage of Pinel often appears in his papers like a central figure of the psychiatry, analyzed far from both hagiography and demolition. Garrabé can be considered like a "psychiatrist-historian", erudite as well as critical. [ABSTRACT FROM AUTHOR]

The phenomenon of child soldiers constitutes a major challenge in the reconstruction of societies after armed conflicts. Children are often forcefully enrolled to fight in armed groups. However, very few studies focus on the voluntary enrollment of children into armed groups. The aim of this paper is to show that understanding the reasons for voluntary enrollment is necessary for the effectiveness of social reintegration mechanisms. "Voluntary" enrollment has a real impact on the un-enrollment and reintegration of child soldiers into society. During a research mission in the Democratic Republic of Congo, we had individual and group interviews with child soldiers in three reintegration centers. We were also able to interview educators, families and the community to complete the data. Some children voluntarily engaged in armed conflict. This voluntary enrollment is motivated in particular by family mistreatment, cruel violence and loyalty issues. The child then seeks a new group to belong to in order to redeploy his subjectivity. Measures for the reintegration of child soldiers should take into account the motivations behind voluntary enrollment. Cultural items (songs, theater, tales, proverbs, etc.) play an important role in supporting these children towards a return to civil and community life. The originality of this reflection is to emphasize the voluntary aspect of enrollment and to consider it as a lever for social reintegration. [ABSTRACT FROM AUTHOR]

Le trouble dysphorique prémenstruel (TDPM) est caractérisé par l'apparition de symptômes thymiques, physiques et comportementaux, survenant une semaine avant le début des menstruations. Depuis son inclusion dans les troubles dépressifs du DSM-5 en 2013 (la version la plus récente du Diagnostic and Statistical Manual of Mental Disorders de l' American Psychiatric Association), la psychiatrie américaine lui confère le statut officiel de trouble mental. Il doit également être ajouté à la 11e version de la classification internationale des maladies (CIM-11) de l'Organisation mondiale de la santé qui sera publiée en 2017. Dans le présent article, la validité et la pertinence du trouble seront remises en question par une analyse de l'argumentaire des défenseurs et des opposants à l'inclusion du trouble dans les manuels diagnostiques. La symptomatologie du TDPM sera d'abord comparée à celle d'autres troubles mentaux, et les facteurs externes reliés au trouble, tels que les événements de vie et la culture, seront examinés. Ensuite, un survol des corrélats biologiques associés au TDPM, ainsi que des facteurs prédictifs (stabilité du TDPM et réponse au traitement médicamenteux), sera réalisé. Finalement, une synthèse critique des résultats de la littérature scientifique sera proposée. Dans la discussion qui s'ensuivra, nous préciserons que ces remises en question ne visent pas à invalider l'existence de l'ensemble des symptômes prémenstruels chez les femmes, mais bien la légitimité de leur inclusion en tant que « trouble » dans les manuels diagnostiques. Premenstrual dysphoric disorder (PMDD) is characterized by thymic (irritability, depressed mood, anxiety), physical (breast swelling, muscle pain), and behavioural (decreased interest, lethargy) cyclical symptoms that appear approximately one week before menstruation and begin to decrease after the luteal phase. Diagnosis considers the degree to which these symptoms have altered social or professional functioning during the year preceding consultation. DSM-III (Diagnostic and Statistical Manual of Mental Disorders) and DSM-IV working groups have successively decided not to attribute an official disorder status to PMDD, apprehending its possible negative impact (e.g., potential increase in prejudice against women through pathologization of natural female functioning and a risk of misuse). Since its inclusion in the DSM-5 (the latest edition of the American Psychiatric Association's DSM) in 2013, it has achieved official status of mental disorder. It is also expected to be included in the 11th revision of the International Classification of Diseases (ICD-11) according to the beta draft of the World Health Organisation. The current paper challenges the validity and relevance of PMDD inclusion in diagnostic textbooks through an argument from both sides on this issue. Criticism about PMDD largely comes from feminist groups, worried about the implications of including the diagnosis and its associated treatments, which are firmly rooted within the medical paradigm. The scientific community, however, is divided, and while some welcome the DSM-5 work group initiative, others are less enthusiastic. The DSM-5 work group identified sufficient empirical support to justify inclusion of PMDD in the Depressive disorders category. Their decision was based on an examination of the four requirements necessary for including any disorder in diagnostic textbooks, that is: (a) a clear distinction of PMDD from other disorders, (b) the presence of antecedent validators (environment and cultural consideration), (c) concomitant factors (biomarkers) and (d) predictive validator (PDMM's stability over time and drug treatment response). The current paper reviews these requirements. A first consideration leading to the inclusion of PMDD in DSM-5 is that it could clearly be distinguished from other mood disorders by the concordance between the premenstrual phase and the symptoms' onset. Indeed, the symptoms begin at the luteal phase and tend to disappear when menstruation ends. However, a meta-analysis reveals some issues in how symptoms ratings have been used in PMDD's studies. Furthermore, it appears that PMDD present high comorbidity with other disorders. A majority (73%) of PMDD cases are combined with another mental disorder (anxiety disorder, mood disorder, etc.). Secondly, PMDD work group advocates the importance of heritability, compared to what they describe as a very modest impact of environmental issues on symptoms' onset. That said, some studies highlight the association between PMDD and various life events and suggest that PMDD is a culture-bound phenomenon. Women who met PMDD criteria would have had experienced significantly more physical and sexual abuse, interpersonal problems, and mistreatment at work than women who did not meet the diagnostic criteria. In addition, women in Western Europe and North America appear to be at greater risk of having PMDD. Third, although no biological markers have systematically been associated with PMDD, notable differences on some gene of women with PMDD have recently been identified. However, biological markers that are characteristic of women with PMDD could be the result of traumatic antecedents rather than the unique cause of this psychological distress. Finally, the work group claims that some predictive factors, which predict the PMDD symptoms' and response to drug therapy, tend to confirm its existence. The fact that symptoms reappear at each cycle would demonstrate the disorder's periodicity and stability. Furthermore, the effectiveness of medications (Selective Serotonin Reuptake Inhibitors- SSRI) in treating this disorder has been a significant factor in the decision of its inclusion in the DSM-5. Nevertheless, the central role played by treatment response in PDMM validation has been challenged by some researchers. Scientific literature review urges to be careful regarding PMDD's place in the diagnostic textbook. Indeed, additional studies concerning discrimination of PMDD from other disorders, life event's role, intercultural issues, and biological correlates are warranted to confirm its validity. To conclude, the arguments raised in the current paper are not intended to invalidate the existence of women's premenstrual symptoms or emotional distress that some women may experience, but rather to debate on the legitimacy of PMDD's inclusion as a "disorder" in psychiatric textbooks and diagnostic manuals. [ABSTRACT FROM AUTHOR]

Récemment, le concept de « pleine conscience incarnée » (embodiment) a été proposé comme dénominateur commun aux approches bouddhistes et occidentales de la pleine conscience (Khoury, Dionne & Grégoire, 2018). Cet article vise à approfondir et élargir cette notion de pleine conscience incarnée afin de démontrer que celle-ci implique nécessairement une prise en compte des aspects interpersonnels et sociaux, souvent négligés dans la théorie, la pratique et la recherche. Des études récentes menées sur les effets interpersonnels de la pleine conscience sont d'abord exposées et des avenues sont ensuite proposées afin de stimuler le développement de ce domaine de recherche. The concept of " embodied mindfulness " (Khoury, Dionne, & Grégoire, 2018; Khoury et al., 2017) was recently introduced and discussed according to both Eastern and Western conceptualizations and operationalization of mindfulness. Our previous papers (Khoury et al., 2018; Khoury et al., 2017) proposed embodiment as a common process that integrates mindfulness across the Buddhist traditions and western schools of thoughts. Moreover, it grounded the notion of " embodied mindfulness " in Buddhist philosophy and neurobiology, namely in the integration of top-down and bottom-up processes. This new notion allowed a common understanding of the mechanisms of change of different Western mindfulness practices, namely Western mindfulness meditation and Langerian mindfulness. It also proposed consciousness as an interaction between the mind, the body, and the outside world. This article aims to deepen and broaden the notion of " embodied mindfulness " by taking into account the interpersonal and social contexts, which are often neglected in the theory, practice and research pertaining to mindfulness. In order to investigate the social dimension of mindfulness, we conducted a thorough qualitative review of theoretical and empirical papers pertaining to the interpersonal, familial, relational, and social aspects of mindfulness and thus, according to both mindfulness-meditation and Langerian mindfulness approaches. Empirical research addressing the interpersonal and social effects of mindfulness in both approaches is presented and discussed. Additionally, we reviewed the state of research in conceptualizing, operationalizing, and measuring the interpersonal/social dimension of mindfulness in both the meditative and Langerian approaches. The results of interpersonal mindfulness are presented and discussed according to the different contexts. In the family context, both correlational and experimental studies have suggested positive effects of mindfulness on relationships between couples (e.g., increase of satisfaction and reduction of reactivity) and on the emotional, social, and behavioral adjustments of children of parents with higher mindfulness disposition or following mindfulness training. The positive outcomes on children were found across different developmental stages (e.g., childhood, early, and late adolescence) and included lower aggressiveness and externalizing behaviors, and more positive interactions with parents and peers, therefore higher self-regulation. The results were also found among both nonclinical and clinical populations, including children with neurodevelopmental disorders such as Attention Deficit and Hyperactivity Disorder and Autism Spectrum Disorder. In psychotherapy context, qualitative and correlational studies suggested that dispositional mindfulness is correlated with an increase in therapeutic alliance and presence, therefore, an increase in therapeutic effectiveness. In addition, an experimental study showed better clinical outcomes among patients seen by therapists practicing meditation than therapists who were in the control group. On the social level, both correlational and experimental studies have suggested positive effects of mindfulness on prosocial behaviors, empathy, altruism, compassion, and reduction in discrimination. These results were obtained in both the meditative and Langerian approaches. According to current research, interpersonal mindfulness, even though globally defined, was only measured in parenting and teaching contexts. Therefore, the need of having a contextually independent measure of interpersonal mindfulness is very high. In light of the empirical results, we believe that the notion of " embodied mindfulness " would benefit from being extended to include more explicitly its interpersonal dimension. Integrating both intrapersonal and interpersonal/social dimensions in conceptualizing and measuring mindfulness can broaden our understanding of mindfulness and its applications and carry important implications in devising new mindfulness-based interventions, which should consider both the intrapersonal and interpersonal dimensions of mindfulness. [ABSTRACT FROM AUTHOR]

Dans cet article, deux visions importantes de la pleine conscience seront présentées. D'une part, la vision de la pleine conscience selon la tradition bouddhiste et d'autre part, les conceptions contemporaines et séculières de Jon Kabat-Zinn et d'Ellen Langer. Ces deux conceptions seront présentées sur les plans théoriques et empiriques. Sur la base d'une fine analyse des facteurs communs à ces deux conceptions (ou visions) et de données probantes issues des neurosciences, le concept de « pleine conscience incarnée » (embodiment) sera introduit. Son utilité dans l'étude de la pleine conscience et dans la compréhension de ses mécanismes de changement sera discutée. La manière dont le concept peut orienter le développement de nouveaux outils de mesure et de nouvelles interventions sera aussi explorée. The interest in mindfulness as a concept continues to grow as shown in the increase in the number of publications pertaining to mindfulness in the last four decades. This increase is also a reflection of the fact that the term "mindfulness" is currently used as an umbrella for a variety of approaches that assign different meanings to the same word. Although differences among varying conceptualizations and definitions of "mindfulness" have been previously highlighted, few efforts have attempted to compare these varying conceptual approaches as a means to address commonalties between them. Therefore, the objective of this paper is to review different conceptualizations of mindfulness in order to understand their common and distinctive components. In order to investigate commonalities and distinctions among different mindfulness conceptualizations, we conducted a thorough qualitative review of theoretical and empirical papers belonging to three approaches in mindfulness: Eastern Buddhist traditions, Western modern mindfulness meditation programs, and Langerian mindfulness. Each of these approaches is presented first at a conceptual level (i.e., how it defines mindfulness) and then at a practical level (i.e., how to operationalize mindfulness). Empirical research pertaining to the effectiveness of each approach is presented and discussed. As Buddhism incorporates different schools of thoughts, this paper focuses primarily on the conceptualization of mindfulness outlined within Theravada Buddhism. It operationalizes mindfulness through an engagement in intensive and daily meditative practice, which includes both concentrative and open-monitoring meditation. In addition, Buddhism includes a set of ethical principles. Western modern mindfulness meditation programs are conceptualized according to Kabat-Zinn and other western scholars. Definitions varied to some extent according to different scholars, each including a different set of components (e.g., attention, awareness, acceptance, nonjudgement, observation). Western modern mindfulness meditation programs are operationalized though the development and implementation of structured psychosomatic interventions, such as Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. Langerian mindfulness is conceptualized as a general style or mode of functioning through which individuals actively reconstruct their environment by creating new categories or distinctions, and seeking multiple perspectives. Langer operationalized mindfulness through a set of sociocognitive tasks. The role of the body in these three approaches and more specifically the mind-body connection is highlighted through the analysis of clinical, behavioral, and neuroscientific research findings. Definitions from both eastern and western approaches share self-regulation of attention and awareness as central common elements. Both attention and awareness processes increase interoceptive and exteroceptive body awareness and mind-body connection, therefore suggesting a role of embodiment in conceptualizing and operationalizing mindfulness across different approaches. We therefore introduce the new concept of Embodied Mindfulness as an integration of top-down and bottom-up processes and argue for its utility in the empirical study of mindfulness across the three conceptual approaches. The new notion of embodied mindfulness integrates different conceptualizations of mindfulness by allowing a common understanding of the mechanisms of change across these conceptualizations. This new notion has also both research and clinical implications. This new notion suggests further emphasizing the body and mind-body connection in both studying/measuring mindfulness and in developing/validating clinical interventions. [ABSTRACT FROM AUTHOR]

Il est courant de dépeindre la psychanalyse et la psychopharmacologie comme deux approches du fait psychique théoriquement contradictoires. Cet article entend démontrer, à travers un regard historique, qu'à l'opposé du cloisonnement actuel des deux domaines, les deux champs ont partagé à l'origine, dans leur moment d'émergence, bien plus qu'il n'y paraît. Pour ce faire, l'article propose de revenir sur l'avènement simultané de la « pharmacopsychologie » sous la plume de Kraepelin et de la « métapsychologie » sous la plume de Freud. Les projets respectifs des deux « pères » de la psychiatrie moderne, avec leurs nombreuses interactions, sont analysés en leur complexité, en recourant à une analyse précise des grands textes, pour certains inédits en français, du corpus kraepelinien et freudien. Cela permet d'envisager, en un second temps, aussi bien l'espoir que Freud a placé dans l'avenir de la pharmacologie que le destin de la psychanalyse à l'ère des neuroleptiques. Au-delà de leur naissance conjointe, il est frappant de constater que métapsychologie et psychopharmacologie connaissent toutes deux un développement parallèle fait, parfois, de synergies inattendues. La « relation symbiotique » existant un temps entre les deux disciplines, l'une aidant l'autre et réciproquement, mérite donc d'être analysée selon ses différentes implications cliniques et théoriques. Si les nouveaux agents pharmacologiques ont été salués par les psychanalystes pour les nouvelles possibilités psychothérapeutiques qu'ils leur ouvraient, leur accueil favorable au plan pratique s'est également doublé d'une réception parfois complaisante au plan de la théorie psychanalytique elle-même, laquelle a parfois eu l'ambition de rendre compte « métapsychologiquement » des effets pharmacologiques. Une strate de réception sans doute plus porteuse a prolongé l'histoire de cette relation synergique en mettant par ailleurs au jour les enjeux extra-pharmacologiques des prescriptions psychotropes, lesquelles se chargent toujours de significations contextuelles et engagent systématiquement autre chose que l'action pharmacologique propre, se répercutant sur la relation médecin-malade. De nombreuses articulations, passées et présentes, invitent en réalité à déjouer le cloisonnement artificiel des deux champs – notamment pour mieux mettre en valeur, aujourd'hui, les facteurs psychodynamiques à l'œuvre dans toute intervention psychopharmacologique. De plus amples recherches méritent d'être entreprises pour mieux comprendre psychanalytiquement les aspects non-pharmacologiques qui renforcent ou inhibent les effets spécifiquement pharmacologiques, modèrent l'adhésion au traitement, et médiatisent l'alliance thérapeutique. Although it is easy to portray psychoanalysis and psychopharmacology as separate and contradictory approaches of the psychic phenomena, the aim of this paper is to highlight that the two disciplines have shared a common historical context, some epistemological traits, and even some theoretical alliance at their very beginnings and during the 20th century. In order to achieve this objective, the article re-examines through an historical perspective both Emil Kraepelin's very first experimental project of a genuine "pharmacopsychology", and Sigmund Freud's invention of "metapsychology", which were formed almost simultaneously. Through an in-depth analysis of the main texts in the Freudian and the Kraepelinian corpus (some of which have not been translated into French), we analyze the theoretical frameworks of the two so-called "fathers" of modern psychiatry, as well as their complex interactions. This leads to explore, as a second step, why Freud himself envisioned with hopeful optimism the coming era of psychopharmacology, and why psychoanalysis initially expressed a positive attitude towards the burgeoning influence of pharmacological psychiatry. Strikingly, before the shift in our field from the subjectivity-oriented psychiatry to the more scientific model of the biological psychiatry, metapsychology and pharmacopsychology have grown side by side, with many unintended mutual synergies. This is especially true during the 1950s, when psychoanalysts had come to dominate the whole psychiatric field at the same time as psychopharmacology had begun its revival, thanks to the chlorpromazine discovery. The historical examination of this symbiotic relationship existing for a limited time between the two fields leads to understand how and why they interacted together, both from a practical and theoretical points of view. Although some psychoanalysts simply acknowledged that the new pharmacological medications were indispensable for helping difficult patients make use of psychotherapy, and advocated therefore the integration of psychological and biological treatment modalities, many others intended to offer in addition some psychoanalytic hypothesis for the pharmacological effects, and proposed the metapsychology as a useful explanatory tool for examination of drug effects upon the psychic apparatus. More interestingly, psychoanalytical framework has also contributed to highlight the many oft-neglected clues that speak powerfully to the influence of psychological and interpersonal factors in psychopharmacology. Because the pure pharmacology of drugs can hardly account for all the clinically observable effects, psychoanalysts have invited to acknowledge some extra-pharmacological factors, like the nature of the patient's relationship to the physician and their attitude toward the drug that may play a crucial role in psychiatric treatment outcome. Many interactions encourage a breaking down of barriers, in order to emphasize the psychology of psychopharmacology, and to specify the therapeutic effects that are connected with the use of psychotropic drugs beyond their pharmacologic specificity. Further research needs today to be done – related to patients' expectancies, treatment preferences, drugs' prescientific representations, etiological beliefs, and their positive or adverse effects on therapeutic alliance and outcomes – to better understand how nonpharmacologic aspects of medications play a crucial role in psychiatric treatment. This could help to clarify the modalities of the psychological and biological treatments association. [ABSTRACT FROM AUTHOR]

La loi de financement de la Sécurité sociale du 14 décembre 2020 a instauré un contrôle des mesures d'isolement et de contention. L'application de cette loi pose des problèmes pratiques quasiment insolubles. La profession, arguant de ces difficultés, proteste massivement et quasi unanimement. Cela empêche une vraie réflexion sur ces deux pratiques et place la discipline dans une défense corporatiste de méthodes musclées. Pourtant une étude du début d'application dans un hôpital spécialisé montre que la diminution de la quantité et de la longueur des isolements est possible (de l'ordre de la moitié) et pourrait aboutir avec des moyens supplémentaires à la disparition de ces pratiques. The Social Security Financing Act of 14.12.2020, in Article 84, establishes a control of isolation and restraints (measures) in health facilities providing psychiatric care without consent by the liberty and custody judges. From now, isolation and restraints only affect hospitalized patients without consent. The restraints must be limited up to 6 h, and the isolation up to 12 h. Exceptionally, they may exceed this period with an obligation to inform the judge of the freedom and the people listed in Article L 3211-12 of the CSP, i.e. the patient and his relatives. The application of this law poses practical problems: (1) the 12-hour time for isolation can include the patient's wake-up call. The twice daily medical visit probably requires to double the number of carers in some hospitals; (2) the failure to comply with medical confidentiality, as there exists now communication to third parties, without informing the patient/against the patient's advice. Many of the motions emphasize the need for the hospital administration to be involved in the transmission of documents. The aim of our paper is to assess the impact (of the application) of such law on the decrease in the number of isolation cases in one specialized/psychiatric hospital. Our objective is to quantify/verify/assess the potential decrease in the number of isolation cases brought by (the application of) such a law in one specialized/psychiatric hospital. At the hospital Valvert, we have 4 pavilions of 24-bed for the 4 sectors (hence 96 beds per sector), with two isolation rooms (for each sector). To assess the impact of the law, we compare the occupation time of the isolation rooms (relative to the number of patients) at two different periods: one period from January the 1st to March the 15th, 2020 (before the enforcement of the law), the other from January the 1st to March the 15th, 2021 (after the enforcement). Our results show a net decrease in the occupation time of the isolation rooms. Moreover, the number of isolation cases has decreased. Over the 2021 period, the occupation time of isolation rooms is 110 days and 10 hours, while the capacity of the hospital is 592 days for this period. The average occupation rate of the rooms is 1.5 out of 8 in 2021, half of the occupation rate in 2020 (3 out of 8). The 2016 and the 2020 laws are rather symptomatic of the confusion between politics, legal and administrative. Even if isolation and restraints would go against patients' rights, should we necessarily ban them? The risk is that after the ban comes the segregation and that means that our open services and hospitals should be closed. One of the solutions to avoid segregation could be to strengthen the capacity of the constitutional institution, including psychiatric follow-up of patients in the hands of justice. We are experiencing the paradox of our modern society with an unparalleled degree of security and increasingly at-risk living... For sure, risk zero in psychiatry is an utopic goal. [ABSTRACT FROM AUTHOR]

Clérambault a posé le diagnostic de « paranoïa » concernant le roi Louis XI (1423–1483). L'objectif de cet article est de rendre compte des divers éléments qui permettent de questionner ce « diagnostic ». Après avoir fait une revue de la littérature psychiatrique au sujet du « cas » Louis XI, nous questionnerons les historiens, puis, considérant l'ensemble de ces recherches, nous mettrons en relief la « méfiance » pathologique du roi, que nous analyserons à la lumière de la psychopathologie et de l'orientation psychanalytique. Le roi Louis XI a été surnommé « l'homme le plus méfiant qui soit ». Au-delà de cette méfiance caractérisée, il semble bien également avoir manifesté des idées de persécution et des préoccupations hypocondriaques. Le diagnostic de « paranoïa » – mais, pour nous, une paranoïa non déclenchée, non délirante – semble pouvoir être retenu, eu égard notamment à la conception qu'en avait Clérambault. La discussion principale est relative à la notion de « méfiance » en psychopathologie, et à son rôle qu'elle peut jouer sur le mode d'une « défense réussie » dans la paranoïa. Compte tenu d'un certain consensus – parmi les références psychiatriques, mais aussi parmi les historiens – il est fort probable que Louis XI ait présenté une forme de paranoïa, avec idées de persécutions, tyrannie, cruauté, soif de pouvoir, préoccupations hypocondriaques, le tout en un sens « contenu » par une méfiance extrême qui semble l'avoir mis à l'abri d'un délire systématisé. Clérambault issued the diagnosis that King Louis XI (1423–1483) was paranoid. The objective of this article is to enumerate the various elements that make it possible to question this "diagnosis". After reviewing the psychiatric literature about the "case" of Louis XI, we consulted historians, and then, considering all of this research, we highlight the king's pathological sense of "distrust" which we then analyze in the light of psychopathology and psychoanalytical orientation. King Louis XI was nicknamed "the most suspicious man ever". Beyond this characterized distrust, he also seems to have manifested a persecution complex and hypochondriac concerns. As far as the diagnosis of "paranoia" is concerned, – a non-triggered, non-deviant paranoia seems to us to be appropriate, especially in view of Clérambault's conception of it. The main discussion is related to the notion of "mistrust" in psychopathology, and the role it can play as a "successful defense" in paranoia. Given that there is a certain consensus – among psychiatric references, but also among historians – it is very likely that Louis XI presented a form of paranoia, with ideas of persecution, tyranny, cruelty, thirst for power, and hypochondriac concerns, All in a sense "contained" by an extreme distrust which seems to have sheltered him from a systematized delirium. [ABSTRACT FROM AUTHOR]

Anorexia nervosa is a severe and potentially life-threatening disorder. However, although the role of parents in treatment is now clearly recognized and therapeutic groups for parents have been used for years, there are but few existent studies concerning their organisation and effectiveness. The objectives of this study were, on the one hand, to evaluate the parents' and therapists' subjective experience of these groups through a systematic review of the literature, and on the other hand, to assess the state of current practices in France using an online questionnaire. The Medline and Web of Science databases were systematically searched. French practices were explored through a questionnaire sent by e-mail to French units treating patients suffering from anorexia nervosa. Eleven studies were identified, ten of which used only subjective assessment without a control group. They all converged toward the same conclusion: therapeutic groups are perceived, by parents and therapists, as an interesting option in the treatment of anorexia nervosa. The group process allows parents to gain insight into their family dynamics. Therefore, they were able to replicate at home what they have learned during the sessions. The evaluation of French practices showed that one third of the units used a therapeutic group. The frequency and duration of the sessions were relatively homogenous: 75.7% were held once a month or every two months and the average duration was 90 minutes. Other characteristics of the groups were more heterogeneous. While the level of evidence supporting the use of therapeutic groups for parents of patients with anorexia nervosa is low, the perceived effectiveness of these groups is high, both among parents and therapists, and they are commonly used in France. Further research is needed to evaluate their effectiveness. [ABSTRACT FROM AUTHOR]

L'objectif de cet article est de présenter en langue française une revue des connaissances actuelles sur les conséquences et déterminants de l'accommodation familiale. Celle-ci peut se définir par les changements de comportements qu'adoptent les membres d'une famille d'un proche souffrant de trouble mental dans le but de diminuer la souffrance et la détresse qui y sont associées. Afin de présenter ce mécanisme, l'article en abordera les modèles théoriques sous-jacents dans le trouble obsessionnel compulsif (TOC). Une seconde partie traitera des principaux programmes et méthodes de prise en soin de l'accommodation familiale. Pour ce faire, une revue de la littérature concernant l'accommodation familiale a été réalisée à partir des bases de données suivantes : PubMed, Google Scholar, ScienceDirect et PsycINFO, cela sans limitation de date. Soixante-sept articles ont été retenus afin d'aborder la question de l'accommodation familiale dans les TOC, aussi bien auprès d'une population enfants que d'une population adultes. Il en résulte que les données de la littérature montrent clairement que l'accommodation familiale est (1) un facteur important de maintien de la symptomatologie TOC et anxieuse ; (2) négativement associée à l'efficacité des interventions psychothérapeutiques. En ce sens, de nombreuses propositions d'interventions, issues des modèles en TCC, ont vu le jour ces dernières années afin de maximiser l'efficacité des thérapies du TOC et des troubles anxieux. Pour conclure, mieux comprendre l'accommodation familiale et en tenir compte dans l'ensemble des pathologies psychiatriques paraît essentiel à l'avenir afin d'augmenter l'efficacité des propositions de soin. The objective of this article is to present a review of current knowledge of the consequences and determinants of family accommodation in adults, children and adolescents. Family accommodation can be defined as the changes in behavior adopted by family members of a relative suffering from a mental disorder in order to reduce the associated suffering and distress (e.g., participating in OCD rituals or helping with avoidance). This phenomenon is particularly frequent since it is observed in from 70 to 97% of the relatives interviewed in the studies, whether the patients are adults or children. To present this mechanism, this article will discuss the underlying theoretical models in obsessive-compulsive disorder (OCD) as well as outline the epidemiology, consequences and maintaining factors of family accommodation. The second part of this article will deal with the principal programs and methods of treatment of family accommodation. To this end, a review of the literature regarding family accommodation was conducted using the following databases: PubMed, Google Scholar, ScienceDirect, and PsycINFO, without date limitation. Sixty-seven articles were selected to explore the question of family accommodation in OCD, both in child and adult populations. The data in the literature clearly show that family accommodation is an important factor in the perpetuation of OCD and anxiety symptomatology. Indeed, this accommodation would seem to impede attempts to learn new functional behavior by not allowing the person to perceive the negative consequences of his or her symptomatic behavior or by preventing him or her from experiencing habituation to anxiety-provoking stimuli. In addition, several studies have shown a moderate correlation between the intensity of OCD and family accommodation, as well as the negative effects on the quality of the relationship in couples, or an increase in the perceived burden for the relative. Another finding that seems relevant to clinical practice is that family accommodation is negatively associated with the effectiveness of psychotherapeutic interventions. Indeed, it has been shown that a high level of family accommodation is positively correlated with a low response to psychotherapeutic and pharmacological treatments. Family accommodation has been shown to be a factor in the failure of psychotherapies by distorting the learning achieved in therapy, as well as by leading to greater functional deterioration in the patient. This accommodation is also a predictor of non-spontaneous recovery. These data, therefore, indicate the importance of considering this mechanism in the treatment of patients suffering from OCD, regardless of their age or sex. In the second part of the article, we discuss many proposals for interventions, based on CBT models, which have emerged in recent years in order to maximize the effectiveness of therapies for OCD and anxiety disorders. Their aim is to integrate the family member into the therapy so that he or she can understand the interest in changing his or her reinforcing behavior. In addition to understanding the importance of change, they can be helped by the therapist. Most of these programs are for children only, but some do exist for relatives of adult patients. These propositions for the treatment of family accommodation seem to demonstrate interesting evidence in favor of their effectiveness. However, considering the small number of existing programs, and the small sample sizes that have led to their validation, further research is needed on this topic in order to highlight key interventions that can lead to a decrease in family accommodation. In conclusion, despite an acceleration of research during the last decade, family accommodation remains relatively insufficiently studied, particularly in adults. Recently, family accommodation has been demonstrated in cases of depression, all anxiety disorders, autism spectrum disorders, eating disorders and in chronic pain. There is still a lack of evidence for the existence of this process in certain disorders such as schizophrenia or bipolarity, but it is easy to hypothesize that a change in behavior can be found in the relatives of people suffering from these types of pathologies. In consideration of these results and of the negative impact of family accommodation on the treatment of mental pathologies, a better understanding of family accommodation and its consideration in all psychiatric pathologies seems essential in the future in order to increase the effectiveness of treatment proposals. [ABSTRACT FROM AUTHOR]

Given the growing number of dependent elderly and of young children who attend day care centers, and in order to foster intergenerational links, intergenerational programs (IG) or facilities have been developed. However, research in this area is still emerging in Europe. Most of the available studies have been carried out in the United States and focus on the content and modalities of IG programs and their impact on elderly and children. We conducted a systematic review of the literature aimed at presenting a synthesis of the benefits and challenges related to this type of program or facility, both for children and the elderly. This systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method and the methodological quality of the selected articles was assessed using the Mixed Methods Appraisal Tool (MMAT). Studies were identified in February 2021 from the PubMed, PsycINFO and Google Scholar databases. Only scientific articles in French and English published between 1986 and 2020 were selected. Other inclusion criteria were: studies with samples of children up to 6 years old and adults at least 65 years old; IG programs with at least one weekly IG meeting. We used the following search combination: intergenerational AND nursing home OR care homes OR long term care OR residential care OR aged care facility OR child care centers OR daycare OR preschool education OR pre-k OR elders OR elderly OR older people OR seniors OR children OR kids OR youth OR child. The benefits seem quite obvious for the elderly in terms of positive emotions, involvement in activities, and self-esteem. Children also benefit from these intergenerational programs, particularly through a better understanding of the abilities and limitations of the elderly, thereby fostering greater empathy towards them. Several IG programs have implemented Montessori activities to bring children and elderly together. Despite the positive impacts described, to achieve their goals IG programs need to meet several criteria, particularly appropriate planning that takes into account individual needs and skills, and adequate staff training. If IG programs are not sufficiently well-prepared, their impact may be null or even opposite to the expected goals, generating frustration in the elderly or reinforcing stereotypes in the children. Another risk is the infantilization of the elderly, such as involving them in activities that are inappropriate to their age and dignity, or doing things for them rather that promoting their active participation. The selected studies have limitations that should be considered for future research. Most studies were conducted on small samples, which prevents from generalizing their results. In addition, results are often based on qualitative or subjective information, sometimes concerning only part of the participants. Finally, most of the studies are purely descriptive, and therefore did not allow for pre- and/or post-testing. This literature review can guide practitioners and researchers in defining their IG programs and projects protocols. [ABSTRACT FROM AUTHOR]

Depuis leur création en 1843, les Annales Médico-Psychologiques font paraître des éloges, des historiques sur la vie et les travaux d'aliénistes, des rapports de ceux qui demandent leur adhésion à la Société Médico-Psychologique, des notices nécrologiques... : un ensemble de documents qui servent à la réalisation de biographies. Celle d'un aliéniste est une histoire ou un récit de vie, avant tout documenté sur des titres hospitaliers ou universitaires, sur ses travaux scientifiques (mémoires, publications, thèse...), sur sa participation à des sociétés savantes, sur ses services rendus dans les établissements, institutions ou commissions, sur ses missions à l'étranger, etc. Ainsi, la vie de l'aliéniste nous est connue par son action professionnelle dont il nous faut en extraire un portrait. Dans cette contribution qui s'appuie sur Aspect de la biographie d'André Maurois (1885–1967), nous invitons le lecteur à emprunter le chemin parfois insolite que nous avons parcouru depuis notre rencontre avec Joseph Biéder (1923–2017), psychiatre et ancien président de la Société Médico-Psychologique (1992), et celle avec André Berne-Joffroy (1915–2007), critique littéraire et artistique, essayiste, collaborateur de La Nouvelle Revue Française. Celles-ci nous ont conduit à d'autres rencontres mais virtuelles qui, au fil du temps, nous ont permis de témoigner du récit de vie d'aliénistes méconnus ou discrets. La rédaction de biographie d'aliénistes participe à l'enrichissement des connaissances dans le champ de la psychiatrie et a ce pouvoir de transformation et de transmission générationnelle. Mais elle a aussi celui de faire revivre par les mots une vie sauvant le biographié de nos amnésies. Since the first edition in 1843, the Annales Médico-Psychologiques have published reviews, biographies of the life and works of alienists, resumés of those applying for membership of the medical-psychological society, and obituaries...: a whole collection of documents which provide rich resources for biographical research. The biography of an alienist is constructed around their university and hospital qualifications, their scientific work (theses, research papers, and publications), their contribution to learned societies, their service in institutions and commissions, and their overseas assignments, etc. As such, an alienist's professional achievements form the canvas upon which a life portrait is painted. In this article, which draws upon 'Aspect de la biographie' by André Maurois (1885–1967), the reader is invited on an unusual biographical journey which was first taken following our encounters with Joseph Biéder (1923–2017), psychiatrist and former president of the Société Médico-Psychologique (1992), and with André Berne-Joffroy (1915–2007), literary and art critic, essayist, and contributor to La Nouvelle Revue Française. This journey has led the reader to other virtual encounters, which over the course of time, have shone a light on the lives of lesser known or more discreet alienists. Biographical accounts of alienists have an important contribution to make in advancing knowledge in the field of psychiatry especially in relation to issues of generational transmission and transformation, but also in reviving and commemorating forgotten life stories. [ABSTRACT FROM AUTHOR]

Le personnage du clown a fait sa première apparition à l'hôpital au sein des unités pédiatriques où les effets positifs de son action sont largement reconnus. Cette « activité clown » est néanmoins encore très peu répandue dans les services de psychiatrie où les patients, qui parfois ont du mal à accéder à l'humour, ou qui sont aux prises avec des émotions fortes qu'ils ne parviennent pas à exprimer, pourraient bénéficier de ses vertus cathartiques. Dans cet article, nous présentons dans un premier temps les résultats d'une mini-revue de la littérature portant sur la place et le rôle du clown dans la démarche de soins en psychiatrie. Dans la seconde partie de l'article, nous présentons les résultats de notre étude dont l'objectif était de mesurer le sentiment de bien-être des patients psychiatriques par une échelle visuelle analogique (EVA) après deux semaines de participation à l'atelier clown. Il s'agit d'une étude pilote de faisabilité ouverte, prospective et monocentrique qui s'est déroulée de juin 2015 à décembre 2016 à l'Unité d'Hospitalisation Temps Plein (UHTP) du site de l'EPS Ville-Évrard à Saint-Denis, Pôle 93G03. Cinquante-neuf patients ont été inclus dans l'étude après recrutement par un médecin investigateur chargé de vérifier les critères d'inclusion et de non-inclusion. L'analyse des articles recensés dans la mini-revue souligne les gains des patients en termes de capacité de communication et de gestion des émotions. Par ailleurs, les résultats de notre étude n'ont pas montré de différence statistiquement significative (p < 0,7). Bien que notre étude n'ait pas montré de différence significative, elle a mis en évidence la faisabilité de ce type d'atelier au sein d'un service de psychiatrie et fournit des arguments en faveur de la poursuite de cette activité sur une plus longue période et au sein de structures telles que l'HDJ ou le CATTP. In psychiatry, we often talk about therapeutic mediation, used in many group and individual therapies. We use a wide variety of mediating objects, cultural means and even people, their roles and the image they project, including the character of the clown. The word clown immediately sends us back the image of a comedian working in the circus world or in the royal courts. Yet, modern clowns are now taking different places. The 1980s marked the beginning of the era of "Doctor Clowns" in hospitals. The character of the clown made his first appearance in hospital in pediatric units where the positive effects of his action are widely recognized. This "clown activity" is nevertheless still not very widespread in psychiatric services where patients, who sometimes have difficulty accessing humor, or who are struggling with strong emotions that they cannot express, could benefit from its cathartic virtues. In this article, we first present the results of a mini-literature review on the place and role of the clown in the psychiatric care process. In the second part of the article, we present the results of our study whose objective was to measure the feeling of well-being of psychiatric patients by a visual analog scale (VAS) after two weeks of participation in the clown workshop. For the conduct of the research of scientific articles, we have chosen the databases according to their relevance in scientific, psychiatric and psychological research. These are the following areas: PubMed, PsycInfo, ScienceDirect, LiSSa... No time limit has been set given the low availability of articles in this area and its recent development. For the same reason, all types of scientific papers, as well as some books have been considered. We have selected the articles in French and English. Furthermore, our study is an open, prospective and monocenter pilot feasibility study that took place from June 2015 to December 2016 at the Full Time Hospitalization Unit of the EPS Ville-Évrard site in Saint-Denis, pole 93G03. Fifty-nine patients were included in the study after recruitment by an investigating physician responsible for verifying the inclusion and non-inclusion criteria. The aim was to offer hospital patients in psychiatry a group activity around the theme of humor. This mediation was coordinated by a professional clown with previous experience of hospitalized patients. The activity was 2 hours long, with 8 participants maximum. Description of a session: 1/Time to put on the "clown's outfit" (hat, red nose, wigs...). 2/Relaxation with breathing exercises. 3/Self-presentation through games. 4/The "clown" time which is articulated in two passages on stage, one individual and the other with several people. 5/The conclusion when everyone expresses their feelings about what they have experienced. The main endpoint, namely the participants' sense of well-being, was measured by a Visual Analogue State (VAS) before and after each clown workshop (D0 and D15), i.e. after two weeks of participation in the clown workshop. Analysis of the articles reviewed highlights patients' gains in terms of communication skills and emotion management. Furthermore, the results of our study did not show a statistically significant difference (P < 0.7). Although the results did not show a statistically significant difference, this study highlighted the feasibility of this type of workshop within a psychiatric department. There was no worsening of the clinical condition of the patients during the protocol and no behavioral disorder caused a disruption of the sessions or their premature termination. In fact, all the sessions could be carried out. The patients who participated in the first session were also present during the second one 15 days later. It can be noted that in terms of feasibility, the patients were complacent and joined the group well. They cooperated in this foray into the imagination created by the character of the clown, allowed emotions to be expressed that they did not show during formal interviews. In conclusion, this study provides arguments in favor of the continuation of this activity over a longer period and within structures such as day hospital or part-time therapeutic activity center. [ABSTRACT FROM AUTHOR]

La tachypsychie est un des symptômes fréquemment retrouvée des troubles de l'humeur. Cet article a pour but de résumer les connaissances actuelles sur le contexte historique, la sémiologie et la fréquence de ce symptôme dans le spectre des troubles de l'humeur. La tachypsychie pourrait se scinder en deux composantes : les « pensées accélérées » et les pensées dites « grouillantes ». Dans un état hypomane, la tachypsychie semble être caractérisée par des « pensées accélérées » résultant d'une production d'idées excessives se succédant les unes après les autres. Dans le contexte de la dépression, la tachypsychie semble sémiologiquement différente de celle de l'état hypomane et serait mieux caractérisées par le terme de « pensées grouillantes ». Elles sont caractérisées par un excès de pensées simultanées ayant une composante déplaisante/désagréable. Ces pensées induisent le sentiment que ces idées sont difficiles à saisir. Les « pensées grouillantes » sont aussi différentes des ruminations. Le « Racing and Crowded Thoughts Questionnaire (RCTQ) » développé par Bertschy et al. permet l'évaluation de ce type de symptômes. Par ailleurs, ces pensées sont principalement présentes dans les troubles de l'humeur, mais on peut également les retrouver dans d'autres troubles psychiatriques comme le TDAH et le trouble de la personnalité limite. Une approche dimensionnelle pourrait être envisagée pour ce type de symptôme. La prise en compte de la tachypsychie et de ces différentes composantes semble être primordiale pour une prise en charge la plus adaptée possible des patients souffrant de dépression. Crowded and racing thoughts are frequent symptoms in mood disorders. This paper aims to summarize the current knowledge about historical context, semiology and frequency of theses symptoms in the spectrum of mood disorders. In the context of depression, "racing thoughts" are phenomenologically different from hypomanic state and better described as "crowded thoughts": they are characterized by too many thoughts (occurring at the same time in the field of consciousness) which are described as unpleasant. These thoughts induce the feeling that ideas are difficult to grasp. « Crowded thoughts » are different from rumination too. The Racing and Crowded Thoughts Questionnaire (RCTQ) developed by Bertschy et al. allows the assessment of this type of symptoms. These thoughts are mostly present in mood disorders, but we can also find them in other psychiatric disorders like ADHD and borderline personality disorder. À dimensional approach could be considered for these symptoms. The consideration of these symptoms (racing thoughts and crowded thoughts) seems to be important for a more accurate and better treatment management of people with depression. [ABSTRACT FROM AUTHOR]

L'existence d'un lien entre urbanicité et trouble psychotique est une donnée maintenant clairement établie avec l'existence d'une relation dose–effet : plus le taux d'urbanicité est élevé, plus le risque de psychose est important. Pour expliquer cette association, plusieurs hypothèses ont été proposées. La plupart des études ont évalué le rôle de facteurs psycho-sociaux comme le niveau socio-économique, le surpeuplement des logements, les inégalités sociales, le capital social pour expliquer ce lien. L'ensemble de ces facteurs ont pour dénominateur commun une exposition répétée au stress, responsable d'une neuro-toxicité susceptible de faire le lit des décompensations psychotiques. Plus récemment, des études suggèrent un rôle de la pollution de l'air. L'exposition aux polluants atmosphériques augmente la neuro-inflammation, le stress oxydatif, l'activation de la microglie, causant des dommages cérébraux et favorisant secondairement le développement des troubles psychotiques. Ces facteurs restent pour l'heure insuffisamment explorés et nécessitent des investigations plus poussées, ce d'autant que contrairement à beaucoup d'autres facteurs étiologiques (environnementaux ou génétiques), les stress psycho-sociaux et la pollution atmosphérique présentent l'avantage d'être accessibles à des interventions et des mesures de prévention susceptibles de réduire l'incidence de la maladie. A growing body of evidence suggests that urbanicity contributes to the development of psychosis, with elevated risks being associated with growing up or living in environments with a higher level of urbanization. This article aims to provide a review of the scientific literature studying the link between urbanicity and psychosis in order to identify the concepts used so far to clarify this issue and the hypotheses that have emerged from them. Taken together, the findings reviewed in this paper confirm that urbanicity is associated with an increased risk of schizophrenia and other non-affective psychosis. However, the mechanisms underlying this phenomenon remain unclear. The impact of urbanicity may result from a wide range of factors from air pollution to stressful impact of social life leading to "urban stress". Indeed, the main underlying putative causes explored that may underpin this association are the social environment and air pollution. The role of psychosocial stressors such as neighborhood fragmentation, low social cohesion and social capital, deprivation, social adversities have been singled out by several studies. These different factors could lead to several pathways, possibly unified by dopaminergic hyperactivity in mesocorticolimbic system. Urbanicity could also potentially be related, at least in part, to environmental pollution which has been largely neglected compared to some of the other non-genetic environmental risk factors. The findings from our review show that recent studies link environmental pollution and especially air pollution exposure, to an increased risk of schizophrenia. There are feasible biological mechanisms involving neuro-inflammation processes by which some of the specific pollutants could affect brain development in a way that could increase risk for schizophrenia. Further research – from the cellular to epidemiological levels – is clearly needed. To fully understand the causal role of the environmental risk factors, the integration of genomics with large-scale epidemiological studies is warranted. Moreover, new studies on urbanicity should therefore be more interdisciplinary, bridging knowledge from different disciplines (psychiatry, epidemiology, human geography, urbanism, etc.) in order to enrich research methods. The fact that more than 50% of the World population lives in cities, a proportion likely to increase in the future, makes the resolution of this question an urgent matter. If causation is proven, enhancements of policy intended to reduce human exposure to environmental stressors and pollution could reduce the burden of schizophrenia and possibly other mental illnesses. [ABSTRACT FROM AUTHOR]

Résumé Cette étude consistera en une analyse rétrospective des patients ayant franchi le seuil de la consultation spécialisée de l'Unité de Psychiatrie et de Psychologie Légale (UPPL) de l'Établissement Public de Santé de Ville-Evrard entre le 1er janvier 2010 et le 30 septembre 2016. Basée sur 241 patients, pour la plupart des Personnes Placées Sous Main de Justice (PPSMJ), elle tentera de dégager des caractéristiques sociodémographiques, psychopathologiques, et émettra des observations relatives aux prises en charge dans le cadre de Soins Pénalement Ordonnés (SPO) et la durée de ceux-ci. Méthodologie Pour la réalisation de cette étude, nous nous sommes appuyés sur un recueil des données contenues dans les dossiers des patients, sur une lecture des ordonnances de jugements et de rapports d'expertises fournis, les entretiens d'évaluations et suivis menés. Les données ainsi recueillies furent ensuite comparées avec les données nationales retrouvées dans la base de données Nationale du Casier Judiciaire pour l'année 2014, ainsi que les éléments contenus dans le rapport de l'Office National de la Délinquance et des Réponses Pénales (ONDRP) pour l'année 2015, mais également sur une recherche bibliographique dans les bases de données PubMed, MedLine, Science Direct, CAIRN, en ciblant les termes « soins pénalement ordonnés », « la prise en charge des auteurs d'infractions à caractère sexuel », « risque de dangerosité »... Objectifs Cette étude visera à déterminer quelles sont les caractéristiques des consultants de l'UPPL de Ville-Evrard, quels sont les éléments spécifiques qui ressortent au plan local en comparaison avec les données recueillies au niveau national ? Quels sont les types de sanctions le plus fréquemment prononcées, leur durée, et quelles sont les PEC possibles dans ces délais parfois réduits ? Abstract This research deals with a retrospective look on the 241 inpatients who crossed the threshold of this Specialized Consultation between January 1, 2010, and September 30, 2016. This research aims to highlight socio-demographic and psychopathological features, if any, and to form opinions and hypotheses concerning the treatment of inpatients under mandatory judicial cares. Methods To conduct this research we grounded our hypothesis in a systematic review of files, the gathering of the data contained in those files, and analysis of psychological assessments, and court decisions when available. The data was collected and then compared with the national statistics on crimes in 2015 (ONDRP) and the National Judicial Record. This review concludes with a literature review using databases such as Medline, PubMed, CAIRN, Science Direct searching for the term "Court Ordered Cares", "Sex Offenders treatment program", "Criminological Dangerosity Risk". Objectives This paper aims to determine if there are peculiarities between our active list compared against the national records. What are the main Court Ordered Cares, their length, and what sort of treatment could be initiated within the short term? Results This Specialized Consultation were created 6 years ago in response to an increase in the mandatory supervision involving the psychological treatments of sex offenders. The Paris suburbs (banlieue) were unequally represented at that time and one of the authors of this research decided to start a new consultation designated for this specific population of « patients ». This paper sought to determine if there were some differences between our sample and the national data, from either a psychopathological point of view, or in the categories of crimes. One of our findings was that the length of the mandatory cares mirrored the severity of the judicial sanctions. The mean length of a court ordered care following a sentence, for an offense (exhibitionism, minor sex offenses) was comprised between eighteen months and three years for 76 % of individuals, whereas in cases of serious crimes (rapes e.g.), the length was comprised between three and six years in 71 % of the cases. It could reach a length of six to ten years or more in 15 % of the cases. It might be interesting to consider mandatory cares less than twelve months would not allow for the development of therapeutic bond and thus may prove less effective. Despite a judge's beliefs and hopes, a court ordered care rarely leads to long-term therapy as the probationer tends to regard them as an extension of judicial sanction. [ABSTRACT FROM AUTHOR]