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À l'objectivité supposée de la science pourrait s'opposer une approche centrée sur la subjectivité. Pour autant, une recherche mise au service de la pratique clinique constitue une zone frontière entre ces deux champs, encore faut-il définir les limites de nos actions et leur orientation. La richesse de la clinique en psychiatrie militaire tient au fait que les contraintes opérationnelles, assumées par tous, vont venir mettre en tension les mécanismes de défense psychiques individuels et sont susceptibles de faire émerger des troubles psychiques dits « réactionnels ». C'est pourquoi la recherche en psychopathologie conserve une place de choix dans les armées. En complément de cette approche, la recherche scientifique s'avère précieuse, notamment concernant l'optimisation des thérapeutiques médicamenteuses. À travers l'exemple d'un projet de recherche clinique, consacré à la prescription individualisée des antidépresseurs via la pharmacogénétique, nous proposons d'illustrer le bénéfice d'échanges civilo-militaires dans ce domaine. Ainsi, la recherche clinique constitue une démarche nécessaire tout autant qu'un défi pour les praticiens des armées, permettant à la fois l'émergence d'innovations et l'intégration des apports scientifiques les plus récents, tout en conservant une orientation éthique guidée par les réalités de la pratique clinique. Introduction: The supposed objectivity of science can be contradictory to a clinical approach focused on subjectivity. However, research in the service of clinical practice constitutes a frontier zone between these two fields, and it is still necessary to define the limits of our actions and their orientation. How, beginning with the impediments of the clinic and respecting them, can we question whose interpretation could impact our way of providing treatment? While military psychiatry is a unique practice, clinical research in this environment also has its specificities. The specificities of clinical research : In addition to the psychiatric pathologies encountered in the general population, operational constraints are part of the military profession: the pace, nature, and duration of missions, the hostility of the environment, and the confrontation with potentially traumatic situations, are likely to produce so-called "reactive" psychic disorders. The richness of the military psychiatry clinic in this context is due to the fact that these constraints will put the individual psychological defense mechanisms under stress. Thus, casuistry assumes, from our point of view, a primordial place. This is why research in psychopathology has a special place in our practice. Between heritage and innovations : In addition to this approach, scientific research, whose effects are necessarily normative, proves to be valuable, particularly with regard to the optimization of drug therapies. Through the example of a clinical research project, dedicated to the individualized prescription of antidepressants via pharmacogenetics, we propose to illustrate the benefits of civil-military exchanges in this field. The interest in the military population is all-important: improving the effectiveness of treatments while reducing their side effects could bring about an optimization of care and a reduction in the duration of operational incapacity in personnel with specific jobs. It is also a question of integrating this research into daily practice, i.e. to ensure that its effects are used to benefit the patient. Clinical research is at once a necessary step as well as a challenge for military practitioners, allowing both the emergence of innovations and the integration of the most recent scientific contributions, while maintaining an ethical orientation guided by the realities of clinical practice. [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]

Après avoir rappelé la condition actuelle des parents qui présentent des troubles mentaux graves, nous avons exploré si les patients qui se sentent plus autostigmatisés adoptent un fonctionnement parental moins adéquat. Cent parents avec un trouble mental grave (schizophrénie, trouble bipolaire ou trouble dépressif majeur) ont rempli la version abrégée de l' Internalized Stigma for Mental Illness Scale (ISMI), le Parental Acceptance and Rejection Questionnaire (Parent PARQ) et le Parental Styles and Dimensions Questionnaire (PSDQ). Dans notre échantillon, il est avéré que l'autostigmatisation liée à la maladie mentale, ainsi que les caractéristiques cliniques typiquement associés à la sévérité du trouble (type et ancienneté du diagnostic, antécédents familiaux de trouble mental grave) constituent des facteurs clés pour prédire la qualité du fonctionnement parental. Nos résultats ouvrent sur un débat autour des enjeux institutionnels qui en découlent. After recalling the current conditions of parents with severe mental illness (SMI), we explored whether patients who feel more internalized stigma, adopt less adequate parental functioning. One hundred parents with severe mental illness (schizophrenia, bipolar disorder or major depressive disorder) were administered the abbreviated version of the Internalized Stigma for Mental Illness Scale (ISMI), the Parental Acceptance and Rejection Questionnaire (Parent PARQ) and the Parental Styles and Dimensions Questionnaire (PSDQ). In our sample, mental illness related internalized stigma, as well as clinical characteristics typically associated with the severity of the mental illness (type and chronicity of diagnosis, family history of SMI) were found to have strong predictive value for the quality of parental functioning. Our results broaden understanding of institutional issues regarding SMI parenting assistance services. [ABSTRACT FROM AUTHOR]

Résumé L'infection chronique par le virus de l'hépatite C est un problème de santé publique au Maroc et dans le monde. Elle affecte souvent des sujets présentant des troubles psychiatriques ou des troubles liés à l'abus de substances. Des symptômes psychiatriques sont très fréquemment associés à l'infection par le virus de l'hépatite C et à son traitement par interféron alpha (IFN-a). Il s'agit principalement de troubles de l'humeur qui vont interférer avec la prise en charge de cette maladie et conditionner son pronostic. Notre travail définit comme objectif le dépistage des troubles anxieux et dépressifs chez des patients HVC positifs et candidats à un traitement par interféron au cours d'un suivi de six mois. Il s'est agi donc de déterminer la prévalence des troubles anxieux et dépressifs avant et après l'instauration de traitement par interféron. Nous avons recruté 60 patients au service de gastro-hépatologie à l'hôpital Elghassani. Leur moyenne d'âge était de 59 ans et tous ne présentaient pas de contre-indications à un traitement par interféron. Les patients ont été évalués à trois reprises, un mois avant le traitement, un mois après instauration du traitement puis à quatre mois du début de la cure. Trois virgule six pour cent des patients étudiés ont présenté un trouble anxieux sévère. Ce chiffre est passé à 23,2 % après la cure et la différence est significative (p = 0,000). Un virgule huit pour cent avaient un trouble dépressif majeur ; tous ont été mis sous traitement et tous ont bien répondu. La prévalence est montée à 7,2 % après traitement, et là aussi la différence est fortement significative. Un seul patient a présenté un virage maniaque après instauration d'un traitement antidépresseur. Nos résultats vont dans le sens des travaux qui soulignent l'importance du dépistage et de la prise en charge des troubles anxio-dépressifs au cours de l'hépatite C et notamment au moment de la cure par interféron. Plusieurs mécanismes biologiques et psychologiques sont suspectés de jouer un rôle dans l'apparition de ces troubles. D'autres études ont également mis l'accent sur le profil psychologique des patients porteurs du virus HVC comme facteur important mais notre étude montre des chiffres importants alors que la population étudiée a peu d'antécédents psychiatriques et pratiquement pas de consommation de toxiques. Abstract Hepatitis C virus (HCV) infection is a public health problem in Morocco and the world. It often affects population with psychiatric or substance abuse disorders. Psychiatric symptoms are very commonly associated with infection with hepatitis C virus and interferon alpha (IFN-α) treatment. These are mainly mood disorders that can affect the management of this disease its prognosis. The purpose of our study is the screening of anxiety and depressive disorders in HCV patients treated by interferon during a six-month follow-up. 60 patients were enrolled for this longitudinal study. Their mean age was 59 years. Patients were assessed three times: 1 month before treatment, 1 month and 4 months after onset of treatment. 3.6% had severe anxiety disorder. 23.2% after the treatment and the difference is significant (P = 0.000). 1,8% had major depressive disorder and all responded well to antidepressant treatment. The prevalence rose to 7.2% after treatment with interferon, and the difference is highly significant. Only one patient presented a manic turn after initiating antidepressant therapy. Our results are in line with the work that emphasizes the importance of screening and management of anxiety-depressive disorders during hepatitis C and especially during the interferon treatment. Several biological and psychological mechanisms are suspected to play a role in the onset of these disorders. Other studies have also reported the psychological profile of HCV patients as an important factor, but our study shows significant scores whereas in population with few psychiatric and toxic history. [ABSTRACT FROM AUTHOR]

Résumé L'auteur survole 40 années d'activité du Pr Pierre Pichot à la Clinique des Maladies mentales et de l'Encéphale (CMME) qu'il envisage sous deux périodes : celle de 1946 à 1969, durant laquelle Pierre Pichot a travaillé aux côtés de Jean Delay (dont la Leçon inaugurale de la Chaire a été prononcée le 22 mai 1947), et de 1970 à 1986, où, successeur de Jean Delay, il a dirigé la CMME jusqu'à sa retraite. Abstract The author looks back over forty years of activity of Professor Pierre Pichot, in the Clinique des Maladies mentales et de l'Encéphale (CMME) in Paris, which he is considering under two periods: the one from 1946 to 1969, during which Pierre Pichot worked alongside Jean Delay (whose Inaugural Lecture of the Chair was pronounced May 22, 1947), and from 1970 to 1986, where, successor of Jean Delay, he directed CMME until his retirement. [ABSTRACT FROM AUTHOR]

Résumé Cette recherche s’intéresse aux troubles de la personnalité, à l’impulsivité et aux symptômes dissociatifs présentés par des femmes selon qu’elles ont commis un crime violent contre un membre de leur famille ( n = 16) ou contre une connaissance ou un étranger ( n = 11). Nos résultats indiquent que les femmes qui commettent des crimes violents envers une personne extérieure à leur famille sont plus nombreuses à présenter un trouble de la personnalité ( p < 0,05), notamment antisociale ( p < 0,05), à être impulsives ( p < 0,01), à avoir agressé une personne majeure ( p < 0,05) et à avoir des antécédents judiciaires ( p < 0,05) que les femmes dont la victime est un membre de la famille. On n’observe cependant aucune différence significative entre les deux groupes en ce qui concerne les symptômes dissociatifs sévères. Ces résultats suggèrent que les femmes qui commettent des crimes violents ne constituent pas un groupe homogène et que de plus amples recherches sont nécessaires afin de mieux cerner cette problématique. Objectives Despite societal changes in recent decades, the criminality of women remains far less studied than that of men, even more so when it comes to violent crime. The present study examines specific psychological factors such as personality disorders, impulsivity, dissociative symptoms as well as putative differences in demographic and background characteristics between women who have victimised a family member versus an acquaintance or a stranger. Materials and methods This study compares a group of incarcerated women who have committed a violent crime against a family member (Close-group = 16) with a group of incarcerated women who have committed a violent crime against an acquaintance or a stranger (Acquaintance/Stranger group = 11). These women were 19 to 46 years old at the time of the offense ( M = 33.59, S.D. = 7.617). More specifically, at the time of the offense, 8 (29.6%) women were 36 to 40 years old, 10 (37%) lived with a partner, 21 (77.8%) had children, and 14 (51.9%) were employed. Furthermore, it appears that, throughout their lifetime, 15 (55.6%) women were physically abused, 13 (48.1%) were sexually abused, and 9 (33.3%) had made at least one suicide attempt. Finally, 9 (33.3%) women had prior criminal record. To complete this study, we used the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) Overview and a questionnaire on background data and life events to obtain demographic data and other specific information on the women's life, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) to assess the personality disorders, the Barratt Impulsivity Scale (BIS-11) to measure the level of impulsivity, and finally, the Dissociative Experiences Scale II (DES-II) to obtain the level of dissociative symptoms. We hypothesized that women in the Acquaintance/Stranger group would have more personality issues and that they would be more impulsive than women in the Close-group. In addition, we measured whether there is any significant difference between the two groups in terms of the three dimensions of the BIS-11 as well as regarding severe dissociative symptoms (DES-II > 29). Results No significant differences were found among the two groups in terms of demographic and background characteristics except for age of victims and prior criminal record. Indeed, more women in the Acquaintance/Stranger group had assaulted an adult ( P < 0.05) and had a prior criminal record ( P < 0.05) than in the Close-group. In terms of the first hypothesis, there was a significant difference in personality disorders among the two groups, with more women in the Acquaintance/Stranger group having a personality disorder ( P < 0.05). There was also a significant difference in impulsivity among the two groups, again in favor of the Acquaintance/Stranger group ( P < 0.01). Other results showed a significant difference between the two groups on each dimension of the BIS-11 ( P < 0.05) while there was no significant difference in terms of severe dissociative symptoms. Conclusions These results suggest that women who commit violent crimes are not a homogenous group and that further research is needed to better understand this problematic. [ABSTRACT FROM AUTHOR]

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

Résumé Introduction L’obésité chez l’adolescent reste peu étudiée. Nos observations cliniques au sein d’un centre de traitement de l’obésité en Franche-Comté et l’inventaire des diverses théories sous-tendant une origine psychologique de l’obésité, dans un esprit de recherche initialement intégratif, nous ont conduits à étudier les capacités de conscience émotionnelle ainsi que les représentations d’attachements d’adolescents obèses, en comparaison à un groupe témoin. Objectifs Vérifier, en s’appuyant sur la théorie de l’alexithymie développementale et les observations cliniques d’Hilde Bruch, l’hypothèse d’un lien possible entre difficultés de conscience émotionnelle et insécurité du lien d’attachement et des modèles de relation chez ces adolescents obèses, qui les conduiraient au comportement hyperphagique. Méthode Un groupe de 17 adolescents obèses et un groupe de 21 sujets témoins sont testés. Les participants ont complété plusieurs tests : la LEAS (échelle de niveau de conscience émotionnelle), l’IPPA (l’inventaire de l’attachement aux parents et aux paires), le RSQ (Questionnaire des échelles de relation). Résultats Le groupe d’adolescents obèses présente un niveau de conscience émotionnelle significativement plus bas que celui du groupe témoin. Est retrouvé également de manière significative un déséquilibre des liens d’attachement père–enfant et mère–enfant. Les résultats du RSQ soutiennent l’hypothèse d’une fragilité des modèles de relation d’attachement qui placerait le groupe d’adolescents obèses dans la catégorie « en marge de la sécurité ». Discussion Ces résultats soutiennent l’intérêt d’une prise en charge psychologique de l’obésité chez l’adolescent, avec la mise en œuvre de thérapies dans le champ de la régulation émotionnelle et de la thérapie familiale. Introduction Obesity in adolescents remains little studied. Our clinical observations within center treatment of obesity in Franche-Comté, and inventory of various theories supporting a psychological origin of obesity with integrative spirit of research, led us to study capacities of emotional awareness and attachment representations compared to a control group. Objective In reference to developmental theory of alexithymia and clinical observations of Hilde Bruch, investigate the possible link between capacities of emotional awareness and representations and security of the bond of parent child attachment, among obese adolescents, that lead to hyperphagic behavior. Method Seventeen obese adolescents, and 21 controls were tested. Participants completed the Level Emotional Awareness Scale (LEAS); the Inventory of parent and peer Attachment (IPPA), and the Relationships Scale Questionnaire (RSQ). Results The group of obese adolescents presents a level of emotional awareness significantly lower than the control group. The results of this study show a peculiarity regarding the quality of parent child attachment. There seems to be an imbalance between the security of maternal bonding and paternal bonding perceived by the young obese. RSQ results support the hypothesis that those adolescents are at the margins of security from the perspective of attachment. Discussion The results support the interest of psychological treatments of obesity in the adolescent, by the implementation of therapy in the field of emotional regulation and family therapy. [ABSTRACT FROM AUTHOR]

Objectives of this clinical research were to identify the common process of addiction to psychoactive substances and to defend the validity of the concept of addiction in psychopathology. The methodology, mixing qualitative and quantitative methods consisted to assess in 26 addicts in treatment programs and 34 non addicts; psychoactives substances use (Addiction Severity Index) and modes of personality functioning and organization (Karolinska Psychodynamic Profil et Thematic Apperception Test). Based on the results of clinical assessments, the implementation of a cluster analysis in low visibility, showed that addicts have more psychical avoidance et more narcissistic and object dysregulations than non addicts. These common process are in 71% of the addicts the effect of a massive psychical avoidance in borderline functioning and in 20% the effect of narcissistic and object dysregulations due to an non elaborate depressive problematic in failing neurotic functioning. [Copyright &y& Elsevier]