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Klossowski, who had originally started as a religious seeker of truth in his younger years, will - after his « reversal » - feel himself invested with the role of a « heretic » struggling with the libidinous search for truth. Even as the creator of a perverted metaphysics, he remains a seeker of the revelation of being, now in the role of the divine « adversary » who, thrown back on himself, tends to imitate a religious mystic. The divine is replaced by the whispers of the demon, which Klossowski experiences as « la complicité d'une force "démonique" » in the creation of his artworks. The Diana myth becomes a parable for the act of artistic creation. Sexuality, understood as the primordial ground of creative force that shapes the signe unique, the phantasm, shifts metaphysics to « phantasmaphysics » (Foucault), in which the mystery of the divine is exposed as a delusion (Wahnbild). [ABSTRACT FROM AUTHOR]

The article presents the discussion on language serves as a vessel for commonly held beliefs, and the lexicon bears the imprint of deeply rooted convictions. Topics include dictionaries of proverbs, sayings, adages, mottos, aphorisms, and more, all representing manifestations of a sententious discourse; and studies have focused on the prescriptive value as a common property of this diverse discourse.

Introduction: in Mali, there are no data on the prevalence of mental disorders. The purpose of this study was to describe the clinical and epidemiological features of patients hospitalised in the Department of Psychiatry. Methods: we conducted a cross-sectional study in the Department of Psychiatry at the University Hospital of Point G between January 2014 and December 2018. Data were collected from the medical records of 1105 patients hospitalised for psychiatric disorders. Results: the average age of patients was 32.6 ± 11.1 years, ranging from 13 to 82 years. Male patients accounted for 83.8% (926/1105) of enrolled subjects, 53.2% (588/1105) were single, 18.8% (208/1105) were not employed and 28.2% (310/1105) had primary education. Seventy-four percent (818/1105) had a history of psychiatric disorders, 22.7% (251/1105) were born to consanguineous parents. Drug use was reported in 42.9% (474/1105) of cases, including tobacco 32.6% (361/1105), cannabis 26.0% (287/1105) and/or alcohol 15.6% (172/1105). The demand for care came from families in 87.5% (967/1105) of cases. Aggression was the most common reason for consultation (44.5%; 492/1105). In 67.8% (749/1105) of cases, the diagnosis was schizophrenia, schizotypic disorders or delusional disorders. The first use of care was traditional in 58.7% (649/1105) of cases. Conclusion: people hospitalised for psychiatric disorders from 2014 to 2018 were predominantly young and male with a history of psychiatric disorders. They mainly had schizophrenia, schizotypic disorders and delusional disorders. [ABSTRACT FROM AUTHOR]

The article discusses a forum discussion on the contribution of French historian Michel Vovelle on history of mentalities, probed death, gave depth to lives of the past, their cultures, their emotions, their images, their practices and their beliefs. It mentions installation of major concepts which have advances historical knowledge dechristianization, intermediaries cultural, among others. It also mentions teaching on the handling of concepts and their necessary acclimatization.

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From ordinary beliefs to delusions, we're all susceptible to misguidance. In search of meaning, we tell ourselves stories that resonate with our feelings, and we unconsciously adhere to them. These subjective truths become pathological when the circumstances and terrain lend themselves to it. The causes are manifold and go beyond the realms of psychiatry and medicine. In rehabilitation, we explain the delusional faculty as a failed narrative attempt by the subject in response to uncertainty and confusion. This combats stigmatization while promoting critical thinking as a protective factor., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The processes by which delusions are produced and created enable the subject to reconstruct a reality that escapes him. Several sequences make up the delusional temporality. They are not chronological, but allow us to trace the evolution of fertile moments through to stabilization in delusional certainty., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

When we talk about the clinic of delusional symptoms, we are first and foremost affirming that delusions exist. Professionals working in psychiatry know that delusions can be listened to, that they give meaning to suffering and are part of the history of the subject. Taking the time to reflect on this type of symptom allows us to invest in the clinical field specific to psychiatry, and only makes sense if the clinical approach is based on work referring to the patient's individual history. Maintaining and developing these attitudes to care is essential to the survival of psychiatry as a discipline. Focusing on the clinic of delusion is neither a luxury nor a waste of time., (Copyright © 2023. Published by Elsevier Masson SAS.)

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Résumé Les racines philosophiques, sociologiques et psychiques du fanatisme sont indissociables de ses mécanismes psychopathologiques collectifs et individuels. L’existence d’une « idée fixe » caractérise la personnalité fanatique et la personnalité paranoïaque, mais les fanatiques ne se mettent pas en avant comme les paranoïaques ; ils subordonnent de façon désintéressée toutes leurs activités à des idées d’ordre général. Les paranoïaques sont au sommet dans les organisations de type sectaire. Mégalomaniaques, intransigeants, rigides et rancuniers, ils luttent au nom du bien contre l’ennemi extérieur. La sémiologie fanatique coïncide, sur plus d’un point, avec celle de la passion amoureuse exclusive et idolâtrée. L’intensité de l’investissement affectif du sentiment amoureux avec son caractère exclusif évoque l’idée fixe, inaccessible à la moindre critique et à toute remise en cause. L’idée délirante naît à l’intérieur de la sphère psychique du sujet ; elle est le fruit d’une interprétation qui en est le mécanisme le plus fréquent. L’idée qui guide un fanatique vient de l’extérieur ; il n’y pas d’interprétation ; l’idée a été élaborée par le leader et elle est adoptée à l’emporte-pièce par les fanatiques. Les idées délirantes sont individuelles contrairement aux idées fanatiques qui sont partagées entre plusieurs membres du même groupe. L’étude de cas de A.-B. Breivic, auteur de l’attentat du 22 juillet 2011 et de la tuerie qui a fait 74 victimes, montre la difficulté de séparer terrorisme et folie, fanatisme et paranoïa. Le fanatisme oblige les psychiatres experts à évaluer un individu, sans assimiler celui-ci à son acte, aussi « fou » que celui-ci puisse paraître, acte parfois commis en l’absence d’éléments objectivables d’une « folie » suspectée. Mais l’association d’un trouble de la personnalité complexe, comprenant des éléments fanatiques et paranoïaques avec des manifestations psychotiques, est susceptible de majorer considérablement le risque de passage à l’acte dangereux. The philosophical, sociological, and psychic roots of fanaticism cannot be separated from its individual and collective psychopathological mechanisms. The fanatical personality and the paranoid personality are both characterized by an “idée fixe”. However, fanatics are more discreet than paranoid subjects; and all their activities are subordinated to ideas of general order. One finds paranoid personalities in authority positions in cult-like organizations. Megalomaniacal, intransigent, rigid, and resentful, they fight against an outside enemy in the name of Good. The fanatical semiology coincides, in more ways than one, with that of an exclusive and idolizing romantic passion. The intensity of the affective investment of the romantic feeling with its exclusive character recalls an “idée fixe”, impervious to any criticism or questioning. Delusions are born within the subject's psyche; it is most often the result of an interpretative mechanism. Whereas for the fanatic, the idea comes from the outside: There is no interpretation, and the idea, elaborated by a leader, has simply been taken up by his fanatical followers. Delusions are individual, contrary to fanatical ideas that are shared by several members of the same group. The case of Anders Behring Breivik, whose murderous attack on July 22nd, 2011 left 74 people dead, provides an example of the difficulty in separating terrorism from madness, fanaticism from paranoia. Fanaticism requires forensic psychiatrists to evaluate an individual, without assimilating him to his act, no matter how “mad” the act may appear, and despite the fact that the act may have been committed in the absence of objectifiable elements of a suspected “madness”. But the combination of a complex personality disorder (comprising fanatical and paranoid elements) with psychotic manifestations is likely to significantly increase the risk of a dangerous act. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: L’auteur se propose dans cet article d’établir un partage clinique entre mélancolie délirante et paranoïa, en repérant dans ces deux psychoses les points qui leur sont communs mais aussi ceux qui les distinguent nettement. Méthodologie: Après avoir dressé le tableau clinique psychiatrique classique de la mélancolie délirante en nous référant à H. Ey, nous aborderons dans une perspective psychanalytique – et plus spécialement lacanienne – essentiellement trois grands points de repères qui permettent de distinguer des tableaux cliniques qui peuvent sembler parfois assez proches : le rapport à la ű faute Ƈ, le rapport à l’objet et le rapport à l’Autre. Résultats: Ces trois points essentiels nous conduiront à aborder notamment l’auto-accusation mélancolique et l’accusation paranoïaque, la position d’ű exception Ƈ de ces sujets paranoïaques et mélancoliques, ainsi qu’une certaine communauté des thèmes délirants. Discussion et conclusion: Nous tenterons enfin de savoir si, comme le postulait Freud au sujet du délire paranoïaque, le délire mélancolique est lui aussi une ű tentative de guérison Ƈ. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Le DSM-5 donne une définition du symptôme psychotique indépendante de tout concept de psychose. Chez les patients dépressifs, la présence d’hallucination ou d’idée délirante, quelle que soit leur forme clinique, conduit en principe à diagnostiquer une dépression psychotique et à prescrire des neuroleptiques. Les symptômes psychotiques sont subdivisés par le DSM en ű congruents Ƈ ou ű non congruents Ƈ à l’humeur. Nous discutons de la pertinence d’une catégorie de symptômes psychotiques ű atypiques Ƈ, peu évocateurs d’une psychose au sens classique du terme. Méthode: Discussion de la définition opérationnelle des symptômes psychotiques du DSM, étude d’une série de 16 patients chez qui un diagnostic de dépression psychotique a été posé. Résultats: Sur les 16 patients, deux seulement présentaient des symptômes psychotiques classiques, évocateurs d’une psychose. Chez les autres, le diagnostic reposait sur la présence de symptômes très atypiques, comme des hallucinations visuelles par exemple. Discussion: Chez la plupart de nos patients, le diagnostic de dépression psychotique reposait sur des symptômes atypiques, dont la nature psychotique est discutable. Ces patients étaient tous migrants, originaires de pays pauvres, ce qui suggère une variété d’hypothèses expliquant nos résultats. Conclusions: Une catégorie de symptômes psychotiques atypiques, en complément des types classiques (congruents et non congruents) pourrait être utile pour préciser davantage leurs contours psychopathologiques et implications thérapeutiques. Le DSM-5 a cependant pris une voie opposée, en consolidant le type non congruent à l’humeur comme incluant aussi les symptômes les plus atypiques. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: L’auteur de cet article se propose d’examiner la genèse et l’évolution de la catégorie de manie sans délire chez son promoteur, Philippe Pinel (1745–1826), le fondateur de la psychiatrie française moderne. Méthode: Cette étude est réalisée à partir des observations et des différentes classifications contenues dans le corpus de Philippe Pinel. Aussi, s’appuie-t-elle sur une méthode comparative entre les nombreux documents écrits de Pinel. Résultats: Cet article retrace le parcours conceptuel et sémiologique, des premières descriptions de fureur sans lésion des fonctions de l’entendement, que l’on trouve dans le Tableau général des fous de Bicêtre au nombre d’environ 200 paru en 1794, jusqu’à ses dernières occurrences, vraisemblablement dans la sixième et dernière édition de la Nosographie philosophique ou la méthode de l’analyse appliquée à la médecine publiée en 1818, en passant notamment par sa naissance textuelle dans les Observations sur les aliénés, et leur division en espèces distinctes de 1799. Discussion: Les recherches historiques portant sur la manie sans délire s’étaient jusqu’à présent appliquées à montrer la valeur paradigmatique de cette catégorie, sa place et sa fonction dans le cheminement de la pensée pinélienne. Cependant, aucune n’avait mené d’investigation systématique sur la réalité clinique et nosographique de la manie sans délire chez Pinel. Conclusions: En reprenant de manière détaillée le destin de la manie sans délire chez son créateur, cet article en montre la permanence dans les écrits de Pinel et en examine la réalité clinique. Aussi, peut-on le considérer à cet égard comme une contribution à l’étude des fondements psychopathologiques de la notion de passage à l’acte. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Depuis deux siècles se pose l’épineux problème de la définition du délire dans la psychose. Pendant longtemps – du temps de l’aliénisme – le délire sous toutes ses formes était essentiellement décrit. L’attention était davantage portée sur ses modes d’expressions, ses diverses formes, ses thèmes, ses contenus. Un certain nombre d’auteurs se sont pourtant essayés à définir le délire plutôt qu’à le décrire ; d’autres ont dit en quoi il était difficile voire impossible de le définir. Du délire comme erreur au délire comme ű tentative de guérison Ƈ (Freud), il y a un pas théorico-clinique immense. Méthode et résultats: Nous verrons dans cet article comment depuis deux siècles – depuis Esquirol – la définition du délire a évolué dans le champ de la psychiatrie, et comment grâce à Freud surtout, le délire ne peut plus être seulement conçu comme erreur de jugement, raisonnement faux, comme ű maladie Ƈ, mais bien comme effort subjectif, ű travail Ƈ (Falret) intense de construction, d’organisation, tentative de la part du sujet délirant pour se remparder contre l’insupportable en créant une ű nouvelle réalité Ƈ. Discussion et conclusion: En effet, les significations nouvelles données au monde par le délirant lui permettent d’avoir une forme de ű guide Ƈ dans l’existence, et de renouer a minima avec les autres comme avec le monde des objets. C’est aussi depuis Freud et la psychanalyse réintroduire la question du sujet dans le délire et dans les psychoses en général. Avant d’en arriver à la question du sens du délire, et de sa fonction pour le délirant, nous traverserons donc deux siècles de psychiatrie. Ce parcours, ce ű compendium Ƈ des définitions du délire au cours de l’histoire apparaît comme une étape nécessaire pour quiconque s’interroge sur le délire dans la psychose. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: À partir d’une observation clinique, nous allons dans un premier temps évoquer l’intérêt du diagnostic de paraphrénie et, dans un deuxième temps, décrire les différents liens possibles entre paraphrénie et trouble thymique. Observation: M. B., 42ans, est hospitalisé en soins psychiatriques en péril imminent pour troubles du comportement avec idées délirantes. Initialement, il présente une excitation psychomotrice, une tristesse de l’humeur et un délire bien systématisé en secteur, centré sur sa famille, avec des thèmes mégalomaniaque et de persécution à mécanisme imaginatif et interprétatif. Discussion: M. B. présente tous les critères de paraphrénie. L’hyperthymie retrouvée dans la paraphrénie confabulante pourrait expliquer l’excitation psychomotrice initiale. Dans ce référentiel, au niveau thymique, ce patient présenterait donc un trouble dépressif récurrent et non, comme il a été diagnostiqué, un trouble bipolaire. Quatre hypothèses semblent possibles pour évoquer un lien entre paraphrénies et trouble thymique. Conclusion: La détermination de ce lien entre ces deux types de troubles pourrait permettre de définir une attitude thérapeutique et une simplification de la prise en charge au long cours. [ABSTRACT FROM AUTHOR]

Résumé: À partir de différentes théorisations issues de l’épistémologie psychanalytique, l’auteur cherche à développer une définition la plus opérante possible du délire psychotique. Pour ce faire, il met en tension, d’une part, une conception du délire s’établissant à partir du rapport à la réalité extérieure, et, d’autre part, une approche fonctionnelle de l’activité délirante qui tient compte des enjeux subjectifs du délire. Différents paradigmes théoriques sont ainsi évoqués afin de dégager les implications respectives d’une conception réaliste du délire et d’un abord des formations délirantes à partir de leurs qualités subjectives. Dans cette perspective, il s’agit de considérer le délire moins comme une façon anormale de percevoir le monde que comme une tentative de solution face à la résurgence d’un traumatisme primaire impensé. À partir d’une méthodologie qualitative basée sur l’analyse d’une vignette clinique, l’auteur met en évidence trois principales fonctions auxquelles peut procéder le délire dans son essai de résolution auto-thérapeutique. La première, conceptualisée sous le terme de ű fonction contenante Ƈ, préside à la mise en forme et à la transformation signifiante de ce qui ne peut être symbolisé de l’expérience traumatique. La deuxième, nommée ű fonction localisante Ƈ, tente de situer en dehors du sujet le débordement pulsionnel inhérent au traumatisme primaire. La troisième, appelée ű fonction identifiante Ƈ, permet à la personne délirante de s’attribuer un énoncé identificatoire qui, de manière auto-créée, supplée à l’énigme de son histoire insensée. En outre, l’analyse des données cliniques souligne que ces trois fonctions de l’activité délirante ne se réalisent pas de façon aléatoire mais qu’elles s’articulent selon une logique particulière. Il apparaît ainsi qu’à partir de sa triple opération, le délire psychotique tend à se déployer en un ű processus délirant Ƈ par lequel le sujet peut rendre pensable et supportable le vécu traumatique qu’il a éprouvé au cours de son histoire. Enfin, en se référant aux différents résultats de cette étude, l’auteur propose de reconsidérer les enjeux du dispositif clinique avec des patients délirants. Moins de chercher à supprimer le délire, il s’agirait notamment d’accompagner le sujet psychotique dans l’aménagement des potentialités résolutives que le processus délirant tend à produire. [ABSTRACT FROM AUTHOR]

Résumé: L’entrée dans le grand âge représente un moment de crise où la confrontation à la perte est massive et souvent vécue douloureusement. La perte des capacités physiques, celle des proches, du statut social, du logement, peuvent entraîner un véritable bouleversement identitaire, qui peut soit être dépassé au profit d’un nouvel équilibre, soit, dans d’autres cas, être à l’origine de troubles psychiques. À partir du cas clinique d’une femme âgée de 70ans, résidant dans un Établissement d’hébergement pour personnes âgées dépendantes, nous proposons une réflexion sur la décompensation sur un mode délirant, à thème de persécution, avec, comme toile de fond, un syndrome démentiel débutant. Dans une démarche résolument clinique, articulant une lecture analytique et l’approche phénoménologique, nous nous intéresserons à son histoire ainsi qu’à son vécu actuel en institution tel qu’elle nous le livre durant les entretiens. En nous appuyant sur les mouvements transférentiels à l’œuvre dans la rencontre, nous tenterons de mettre en lumière la manière dont la construction et la reconstruction délirantes peuvent faire sens pour elle, et quelles fonctions le délire peut revêtir, entre autres dans le maintien d’une forme de cohésion identitaire. [ABSTRACT FROM AUTHOR]

Résumé: L’auteur se propose d’examiner un chapitre peu connu de l’histoire de la psychiatrie française, contemporain du passage de l’aliénisme à la psychiatrie. Il s’agit du débat sur les services des délirants des hôpitaux au tournant du xx ℮ siècle. Ce débat résidait d’avantage sur la localisation et le rattachement de ces services que sur leur légitimité. Leur existence et leur développement semblaient faire en effet consensus parmi leurs promoteurs. C’est le lieu d’implantation de ces services qui cristallisait les désaccords entre les partisans de l’asile qui souhaitaient pourtant le réformer et ceux de l’hôpital général. Cet article tente d’analyser les conditions d’émergence de ce débat en le situant dans son contexte historique, en particulier celui de la psychiatrie occidentale de la fin du xix ℮ siècle, et d’en éclairer les enjeux cliniques, idéologiques et universitaires. L’auteur montre qu’il prend racine dans plusieurs projets de réforme institutionnelle attachés aux noms de Jean Étienne Esquirol, d’Évariste Marandon de Montyel et d’Édouard Toulouse, qui connurent des destins bien différents. Si certains des enjeux de ce débat n’ont plus cours de nos jours, en revanche d’autres se trouvent impliqués dans la situation contemporaine de la psychiatrie où la multiplication de l’offre et des lieux de soins s’enracine dans la gestion des populations à risque. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Twenty to 50% of patient suffering from schizophrenia may endure persistent psychotic symptom despite antipsychotic medication. These persistent symptoms interfere with social and work functioning. Psychosocial interventions are needed to improve the course of schizophrenia. The experience of psychosis is often described as very painful. However the use of strategies to block or avoid thoughts, feelings and bodily sensations connected to psychosis is often not efficient and could even contribute worsen the mental state. The type of relationship that people keep with psychosis could, for that reason, have an impact on the experience of distress. Mindfulness training offers a way to change this relation to positive symptoms of schizophrenia. Patients and methods: Four patients with a diagnosis of schizophrenia and one with a schizoaffective disorder followed eight group sessions of mindfulness. Seven different topics were pointed during the sessions, one at a time: introduction to mindfulness; the thoughts; breathing; “allow”; “accept”; coping strategies I; coping strategies II; mindfulness in everyday life. The participants fulfilled weekly evaluations of the discomfort caused by a target psychotic symptom chosen by them. Results: The curve of the discomfort caused by the target symptom improved from before to after training. During semi-structured individual interviews participants reported using “mindful answers” to cope with symptoms, paranoid thoughts and emotions after training. We also have noticed a change in attitude toward thoughts, feelings, and emotions in general, after training. Moreover, we observe that three of the five participants wished to sign up for a second therapeutic group with mindfulness. Conclusions: This therapeutic pilot group demonstrated the feasibility of mindfulness training for outpatients suffering from schizophrenia with persistent psychotic symptoms. The answers of the participants through individual evaluations also showed effects in term of psychological process. In fact, all of them said that they had learned to concentrate in conscience on their psychotic symptoms, and could more or less allowed symptoms to come and go without reacting. This assessment encourages the perspective of future studies to evaluate more rigorously the relevance and adaptation of training with mindfulness in group setting to face persistent psychotic symptoms. [Copyright &y& Elsevier]

Humans are ontologically imperfect. Plato's myth of the Cave extracts from this ontological failure a theory of imperfect knowledge from which, according to him, men cannot escape. More recently, Gestalttheorie has called attention to failures in our visual perception system, showing how the brain interprets optical illusions by leaps of imagination and displacements of the imaginary world. This paper sets out to demonstrate how imaginary constructions are the result of subjective interpretations stemming from sensory illusions favored by the failures of our perceptual system (be they auditory or visual). [ABSTRACT FROM AUTHOR]

The author presents the theoretical work of Paul-Claude Racamier, founder of the Day Hospital La Velotte. Dedicated to psychosis, mainly schizophrenia, his work expresses his creativity and originality. It is described from its earliest conceptions of mother-child relationships and their vicissitudes until its latest developments : the narcissistic seduction, the primal mourning and the origins, alongside with the role of paradox and delusional states in psychological functioning. [ABSTRACT FROM AUTHOR]

Abstract: After recalling the three chronological steps in the recognition of erotomania, first by Esquirol who individualised it from the group of passional paranoid psychosis, then by Ball who described it as a “Chaste Love madness”, and later by Clerambault who specified the characteristics of the syndrome: A delusial fantasy occurring most generally in a woman who believes that a man of higher social class is in love with her, sending her love messages either directly or by telepathy. The symptomatology is very stereotyped, with an interpretative mechanism and the three evolving phases: Hope, Spite and Hate. The characteristics of this syndrome explain why the frame of an erotomaniac psychosis is often shown in films. Four films will illustrate this subject: i) the first one is a typical description of a case of erotomania “Adele H”: The true story of Victor Hugo''s daughter: She followed a young officer from England to Halifax, explaining to everyone that they contracted a secret wedding. But the evolution is not typical, since the hate is directed toward her instead of him and turns to progressive madness constraining her to be in a mental institution; ii) the second one is “Play misty for me” where a woman is harassing a disc presenter every night on a small Californian radio; iii) in the third one, “À la folie pas du tout”, the harassed man is a famous cardiologist; iv) in the fourth one, “Anna M.”, the harassed man is an orthopaedic surgeon. In the four cases, we can note the same evolution toward more and more violent actions against the loved, then hated man, leading to murder attempts against him and to final admission to a psychiatrist hospital, the later being always inefficient. [Copyright &y& Elsevier]

In this paper I intend to survey a few aspects of melancholy philosophical reflection as instantiated by two celebrated philosophers, Arthur Schopenhauer and Emil Cioran. I examine these thinkers' idiosyncratic argumentation of the irrationality of life, the permanence of suffering, egocentrism, buddhism, love, eugenics, misogyny etc., as well as a number of remedies inspired by seclusion, asceticism, or the therapeutic magic of art. [ABSTRACT FROM AUTHOR]

Abstract: The notion of hysterical psychosis implies the paradox of a psychotic genitality. Leaning on the psychoanalytic, phenomenological and gestaltist approach of Gisela Pankow, we try to define this nosographic entity, by underlining in a patient a special kind of relationship with imagos and own body we called dialectic of penetration. In that kind of pathological functioning, De Clérambault''s syndrome could be understood as the realization, in the psychotic experience area, of a sort of intrusive genital sexuality, and delusion as a new performance of œdipal drama on the delusional scene. We finally question the place of a lacunar Oedipus complex in non-schizophrenic psychoses. [Copyright &y& Elsevier]

Abstract: This text is a commentary of one of Lacan''s youth article, in which he isolates the paranoia as a “precocious fixation of a structure”. He thereby opposes his views to classical descriptions of paranoia that include associated pathologies, like paranoid states for example. Moreover, by studying the “purely phenomenological notion of confusional states’ structure” in order to criticize the notion of “character” in the paranoia, we show how he very early requires the notion of structure, which will play a predominant role in his works. [Copyright &y& Elsevier]

Abstract: Generally, patients with psychiatric conditions (hallucinations, delusions) are in a state of suffering, but in some cases they may experience contentment. This mostly occurs in mood disorders (mania), delusions such as erotomania, megalomania, mysticism, visual and genital hallucinations, early influence syndrome, presbyophrenia and Korsakoff syndrome. [Copyright &y& Elsevier]

Abstract: The use of symptom dimensions of schizophrenia (positive, negative and disorganised) as quantitative phenotypes has been proposed as a mean to reduce the heterogeneity of schizophrenia and facilitate genetic research. The aim of the present study was to summarize the results of studies investigating the genetic background of the positive dimension. Several studies suggest a genetic contribution to the reality distortion dimension, but at a lesser degree than for the disorganised dimension. Few studies have investigated relationships between genetic factors and reality distortion dimension. However, some works suggest that genetic variation in DISC1 and COMT may be associated with delusions and hallucinations. As specific cognitive deficits have been suggested as explanations for the positive dimension, new strategies should focused on their correlations with genetic factors. For example, source-monitoring deficits (a presumed cognitive marker for increased proneness to psychotic symptoms) can be observed in subjects with 22q11 deletion syndrome, a region containing candidate genes such as Catechol-O-Methyltransferase (COMT) gene. [Copyright &y& Elsevier]

Abstract: Acute and transient psychotic disorders (ATPD) are common in Africa, particularly in Burkina Faso. In order to determine their epidemiological and clinical features in the psychiatry department of the centre hospitalier universitaire Yalgado Ouédraogo, we brought up a retrospective, descriptive and transversal study over 5 years from January 2003 to December 2007. All patients admitted in the psychiatric yard for ATPD were identified through medical records and patient registers. Data analysis was performed with Epi info 2007. During this period, 1106 admissions were registered and 216 had the diagnosis of ATPD. The study included 188 inpatients with complete files, 149 men and 39 women from 13 to 60 years old. This study showed that the point prevalence of ATPD was 19.53%. It mainly affected single men, in early adulthood (28 years on average), living in towns and working in the informal sector. The main diagnosis was acute polymorphic disorder without symptoms of schizophrenia (71.28% of cases). Delusions of persecution were the most common (43% of the themes). Mechanisms were dominated by imaginative ideas (32.62% of the mechanisms), visual and auditory hallucinations. Under medical treatment, main symptoms disappeared and recovery was obtained after an average of 15 days. We discussed the psychopathology of the ATPD in Africa and particularly in Burkina Faso. Considering their heavy socioeconomic and cultural consequences, their management must be improved by a better knowledge of their determinants and evolution. [Copyright &y& Elsevier]

Abstract: In the history of cinema, two major directors, in two important films, have succeeded in treating the clinic of paranoia in an exciting and rigorous way. Luis Buñuel in El (This Strange Passion) from 1952 delivers a very precise portrayal of a jealous and litigious paranoiac. Roman Polanski''s 1967 The Tenant is a subject''s descent into hell: a subject persecuted by his neighbours who slowly transforms into a woman. We will show how these two cinematographic works give an account, each in their own way, of the paranoiac''s subjective position, that of the accuser, so as to extract the position of a trash object, a humiliated man, in short, a waste object, this being the position he is assigned by the Other. Thus we have a precise account of the state of urgency the delusional subject is plunged into, and a description in fine detail of the progressive rise of anxiety that leads to the pressing necessity for a sacrifice. We shall conclude with the different outcome of the delusion for each of the characters, underlining the originality of Polanski who introduces the question of the passage à l’acte in paranoia. [Copyright &y& Elsevier]

Abstract: The history of the nosographical entity of “Folie à deux”, its semiology and its taxonomy since the xix th Century. The developments of the entity and its supposed refinement, display only a difficulty seizing the characteristics of the “Folie à deux”. To speak about the “folie à deux”, it is above all to speak about the delusion and about its structure. It is a matter of seeing the impasse in which psychiatry falls when it cannot envisage the delusion in a different way, the nosography remains anchored in an exceeded and inaccurate phenomenology, which does not contain all the extent of the phenomenon and which distorts the clinical observation, and comes to the point of fixing the entity''s shape and semiology according only to the points of view of a psychiatrist. The method of the psychiatric diagnosis, as for the observation of the delusion, “is obliterated by a naive reference to reality”, as underlined by Maleval. These questionings come to shake the structure of this entity raised since 1873, and interrogate us about the current events of its diagnosis and the validity of its semiology. From Legrand du Saulle up to the contributions of de Clérambault and Lacan, it is a matter of clearing a passage towards other perspectives of a nosographic entity in evolution. [Copyright &y& Elsevier]

Abstract: Delusional beliefs are – with hallucinations – the most characteristic symptoms of schizophrenia. They are delusional in the sense that they are bizarre, irrational and not understandable in the social and cultural contexts where they emerge. Why do many people with schizophrenia come to believe they are controlled by forces external to their own will? A specific anomaly of the conscious experience of the will to act, due to abnormal neural processing of frontoparietal networks, seems to be at the origin of the formation and maintaining of such false beliefs. [ABSTRACT FROM AUTHOR]

Abstract: Psychoanalytic epistemology considers psychosis to be linked to the resurgence of traumatic experiences that have not been assimilated by subjectivity. The hallucinatory return of this primitive agony faces the psychotic subject with a driving encroachment that attacks his body and disintegrates its unitary organisation. Considering this reliving of traumatic experiences, the authors will present schizophrenic delusion less as a pathological result than as a subjective response that aims to treat the psychic over tension, which fractures the subject''s body identity. Based on several clinical studies, this article will question the healing effect of delusion in schizophrenia. It is therefore concerned with investigating the different functions of delusion and identifying their incidence on the subject''s body image. Using the different clinical examples cited, the authors will then attempt to develop certain therapeutic applications, which contribute to a possible reduction of the body disintegration phenomena in schizophrenia. [Copyright &y& Elsevier]

Abstract: In 1880, the French doctor Jules Cotard presents a clinical description of a physical negation delusion occurring in a melancholia context. In his classical clinical description, Cotard''s syndrome is characterized by a semiological triad as: physical denial delusion, immortality and enormity delusion, and damnation ideas. Nowadays, there has been a decline in the appearance of this syndrome, probably due to the new psychopharmacological treatment approach and also because of the decrease in the number of institutionalized patients. The authors present three clinical vignettes of Cotard''s syndrome. The cases are described through a summary of their personal history, the evolution of the disease and their psychiatric journey. A great part of the description of these cases is focused on the fine semiological analysis of the syndrome''s presentation in each patient. Successively, mental and physical syndromes are described for the three patients. In the first patient, the authors insist on the “germinative phase” which is the period during the progressive development of the disease. In the second and the third cases, a “trigger factor” is well identified. The last case is more atypical because of the precocious disease''s arising. It illustrates that fact, that nowadays, Cotard''s syndrome is not the exclusiveness of seniors but can arise in young people. Secondly, a review of available literature on topic is presented – epidemiological, clinical, psychoanalytical and biological aspects – and analyzed, in order to elaborate a psychopathological study of these three patients. The psychopathological analysis shows the great heterogeneity of this syndrome in terms of way of apparition, clinical presentation, and evolution under specific therapeutics. Through the study of the Cotard''s syndrome in the three patients, authors reveal also that the Cotard''s syndrome is still present on the psychiatric''s disease spectrum but not as in 100years ago, but as an “uncompleted and modified Cotard''s syndrome”. Moreover, the apparition of new techniques of brain exploration, especially functional brain imagery, could be an encouraging way to study more and deeper this particular syndrome. In fact, nowadays, the pathophysiological mechanisms and phenomenological aspects of Cotard''s syndrome are still unclear. [Copyright &y& Elsevier]

Abstract: Mr and Mrs P., recently settled in the area, are experiencing difficulties. Mr P. suffering from depression has to be admitted to the hospital. Mrs P., who suffered for years from bipolar trouble, is sent to the outpatients department for medical supervision of her lithium treatment. Discussions with her and the reading of a text she wrote years before bring back a delirious experience, which happened 20 years ago involving the disturbing strangeness of a world of goats. This looking back into the past becomes the starting point of an intense pictorial productivity on which the psychotherapy will be based… An eight months effort which will succeed in obtaining the normalization of family life and a better adaptability to reality. [Copyright &y& Elsevier]

Abstract: Studies have shown that hallucinations and delusions occur in a number of different populations including psychiatric and nonpsychiatric patients and in nonclinical individuals. However, the majority of these studies have included adult populations. The goal of the present article is to review the research on hallucinations and delusions in children and adolescents. The prevalence, characteristics and nature of hallucinations and delusions in both nonclinical and clinical child and adolescent populations will be presented. The paper will conclude with a discussion of important issues and questions, including various clinical and theoretical implications. [Copyright &y& Elsevier]

Abstract: Cognitive neuropsychiatry is defined as the application of cognitive neuropsychological models to some defined psychiatric disorders. It has been hypothesized that the various delusional misidentification syndromes are at first functional deficits and that they can be analyzed within models of face/person processing, whether these delusions occur in primary or secondary psychiatric disorders. The best interest of this approach is to make testable hypothesis; another goal is to improve our understandings of face/person recognition. The aim of this review is to examine the results of the main studies conducted within this framework. [Copyright &y& Elsevier]

Abstract: The authors aimed to show how difficult the nosography seems to be between unipolar depression and paraphrenia, especially when treatments (even with ECT) were poorly effective. Mrs A. presented megalomania and persecution delusions and for years lived in a chronic delusional state. She suffered from delusions after three depressive relapses but she did not show any dissociation or cognitive impairment. The mechanisms were imaginative, intuitive, without hallucinations, but with little coherence, and delusions were constantly stable. This case brings to mind paraphrenia as an evolutionary state of a persistent major depressive period. It is as if a continuum exists between different kinds of psychosis. The report concerns paraphrenia as a secondary process with thymic disorders, discusses the place of chronic delusion in the nosography, and questions the concept of single psychosis. [Copyright &y& Elsevier]

Abstract: The aim of this study was to examine whether executive deficits underlie positive, negative and disorganisation of schizophrenia. The sample comprised 34 patients (30 males, 4 females) diagnosed with DSM-IV criteria (mean age=35±9.5 years; mean duration of illness since first psychotic symptoms=10.2±7 years; mean years of education=11.7±2.6). Evaluation of patients was performed after achieved sufficient remission (clinically stable for 4 weeks at least, no depressive symptoms at moment of cognitive testing and no medication change during the three last weeks). Symptom dimensions were evaluated using items drawn from the Positive And Negative Symptoms Scale (PANSS). The Negative factor comprised N1 (blunted affect), N2 (emotional withdrawal), N3 (poor contact), N4 (passive, apathetic), N6 (lack of spontaneity), G7 (stereotyped thinking) and G16 (active social avoidance). The Positive factor comprised P1 (delusions), P3 (hallucinatory behaviour), P5 (grandiosity), P6 (suspiciousness) and G9 (unusual thought content). The Disorganisation factor comprised P2 (conceptual disorganisation), N5 (difficulty in abstract thinking), G10 (disorientation) and G11 (poor attention). The mean total PANSS score was 63.3±16 (mean of positive score=14.3±4.7; mean of negative score=18.1±6.3; mean of general score=30.9±8.5). Executive functions were examined through the Wisconsin Card Sorting Test (WCST), the Hayling Test (Tunisian version) and two semantic verbal fluency tasks (simple with one category “animals” and alternating with two categories “fruits and clothes”). Partial correlations between syndrome scores and cognitive scores were examined while holding the effects of other symptoms, age and education level constant. Severity of disorganisation symptoms correlated with high number of perseverative errors (r =0.47, P <0.05) and total errors in the WCST (r =0.37, P <0.05) and with reduced score of alternating semantic verbal fluency (r =–0.39, P <0.05). Severity of both negative and positive dimensions uncorrelated with performance of any of the executive tasks. Also, scores of the Hayling Test (time part B minus time part A; errors part B) and semantic simple verbal fluency (total of correct words) were uncorrelated with symptoms. The present study provides evidence that disorganisation dimension of the PANSS correlates specifically with impaired cognitive flexibility as reflected by high number of perseveration in the WCST and reduced set-shifting in semantic alternating verbal fluency. [Copyright &y& Elsevier]

Abstract: A new interpretation of the onset of schizophrenia is presented based on a mimetic and attributional model of the self as agent. Two separate independent perspectives on schizophrenia will be analyzed and criticized in relation to this model. The first one from the works of Henri Grivois, inspired by the general anthropology of René Girard is therefore oriented toward the mimetic dimension of interactions. The critique will focus on the gratuitous reduction of imitation to the domain of bodily motor functions when a much wider understanding of the concept is needed. The second perspective, proposed by Richard Bentall et al., deals with the attributional style of paranoids and is therefore mainly cognitive. The critique will focus on the reductionist and solipsistic vision of a self unduly equated with self-esteem. I intend to show that their respective mimetic and attributional foci are both needed in order to have a better understanding of the delusional subject, for these two dimensions define the inter-subjective space in which the self is built. As a matter of fact, the self is traditionally described as having two fundamental components, the me or object self and the I or agent self. But only the first one, the me, has been thoroughly investigated by the so-called “social mirror” research tradition which originates in Cooley’s “looking glass self” hypothesis. The “I” has constantly eluded scientific investigation and has therefore been virtually ignored by psychologists in the twentieth century. Many researchers have even proposed abandoning it to the realm of philosophy. However, as soon as the social mirror metaphor is understood as the imitation of others’ attributions to the object self, we may conceive of the agent self as the product of these imitations of attributions along the causal dimension. The “I”, characterized by the feeling of being the first cause of one’s own behavior, would therefore be of no less social origin than the “me”. Attributions of intention, responsibility or causality made by others to the self, when mimetically interiorized, will feed the causal self, the “I”. This unitary and psychological conception of self allows a new interpretation of some characteristic aspects of the onset of schizophrenia. The typical feeling of being a focus of attention of an entourage sometimes extended to the whole world can now appear as just the pathological version of the healthy “centrality” of the self in the « social mirror ». The question is: how does the bifurcation of the dynamics of self towards pathology happen? I hypothesize that if the causal attributions that normally “feed” the self along the agency dimension are too scarce, this will lead the self schema to an “abreaction” which consists of “hallucinating” personal causal attributions in the minute attentions, attitudes and messages provided by anonymous public social interactions. All these signs, when perceived and delusionally interpreted, will help the subject maintain the vital feeling of being a “cause” capable of “effects” which characterizes animated beings as opposed to pawns. Hence, the fact that paranoids are prone to perceive others as having malevolent intentions towards them, far from being explained by Bentall’s hypothesis – since a bad social self image doesn’t improve self-esteem – can be interpreted as their longing for causal attributions. In other words, accusations, malevolent attention and intentions are good for the feeling of agency. This conception might shed some new light on the specific susceptibility of adolescents regarding schizophrenia. [Copyright &y& Elsevier]

Abstract: Disorientation towards people manifests itself during age-related dementia by hypo- or by hyperidentifications (false recognitions). The final stage during which the demented does not recognize his close relatives is sometimes preceded, as an heralding symptom of dementia, by an incomplete nonrecognition: Capgras’ syndrome, a delusion where a close relative is perceived as a double and an impostor. Current interpretation of these phenomena is based on the precepts of cognitive neuropsychology. Aged-related disorientation towards people, apart from naming difficulties, remains an opened question. [Copyright &y& Elsevier]

Abstract: Capgras’ syndrome is the first misidentification syndrome described. It was originally individualized in 1923 by the French psychiatrist Joseph Capgras who termed it “l’illusion des sosies”. The subject has the delusional belief that people emotionally close to him have been replaced by doubles physically similar to the originals, but psychologically different. The impostors are generally persecutors. There is sometimes double of the self. Capgras’ syndrome is the most common of the delusional misidentification syndromes (Fregoli syndrome, the syndrome of inter-metamorphosis and the syndrome of subjective double) but is relatively rare, occurring predominantly in the context of paranoid schizophrenia. However, more recently, it has been estimated that a quarter to a third of these cases are associated with neurological, toxic or other organic disorders. And the course of the Capgras syndrome generally follows the course of the basic illness. Thus, there is some discussion in the literature about whether the delusion of doubles should be considered as a syndrome or a symptom. Moreover, neuro-imaging exploration suggests a link between Capgras’ syndrome and right hemisphere abnormalities (particularly in the frontal and temporal regions). Neuropsychological research has reported the presence of impairments in facial processing (which is an established right hemisphere function). Ellis and Young adapted Bauer’s two routes to face recognition model: one ventral visual-limbic route for the overt recognition and one dorsal visual-limbic route for the covert recognition. These authors propose that Capgras patients present an intact ventral route which leads to physical face recognition, but a disconnected dorsal route which prevents the affective confirmation of this recognition. Capgras delusion would be the mirror of prosopagnosia resulting from the preserved overt recognition coupled with a loss of affective responses. After a review of the literature relative to the psychodynamic approaches of Capgras’ syndrome (feelings of depersonalization, problem of ambivalence, affective trouble, incestuous desires…), we have described an original case of Capgras’ syndrome occurring without an organic or psychiatric context. We suggest a re-examination of this curious trouble: the Capgras’ syndrome would be an autonomic entity, which could consist firstly in a functional deficit of affective identification face, this affectivity trouble could be rationalised by the patient and would lead secondly to a delusional interpretation. Capgras patients would recognise the intimate’s face physically but not affectively. The deficit of affective face identification could be caused by organic lesions or functional troubles (psychiatric troubles) or, in our case, by an isolated functional trouble. This loss of affective familiarity of a close relative could be explored by the Bruyer and Schweich face recognition Test. In the case we are considering, patients would attempt to explain this contradictory information by a delusion. This dissociated perceptual experience (known face but strangeness feelings) could be interpreted to make sense and would then produce Capgras delusion. [Copyright &y& Elsevier]

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Abstract: Mythomania (Dupré, 1905) and pathological lying are imaginative fabrications resorting to deceit, imposture and lying as well as to play and delusion. Whether it be an acute or a long-duration identification to a newly formed or imaginary person, this can be understood either as self entertainment, as a hypo-manic equivalent, or as an identity replacement to restore one''s self-esteem and narcissism. Some clinical examples are given to illustrate these psychopathological perspectives. [Copyright &y& Elsevier]

Abstract: Objective. – To investigate a rare psychiatric disorder called “Koro” which is usually described as a culture-specific syndrome in Asian cultures. This syndrome is manifested by intense anxiety associated with the fear of genital retraction and the belief that complete disappearance of the penis into the abdomen will result in death. Even though some cases have been reported in non-Asian subjects, it is often referred to as a culture-bound syndrome. Method. – A literature and case report review indexed 117 articles or summaries relating to the syndrome of Koro. In addition, the authors report six cases of Koro in Quebec from their clinical practice and open a discussion on clinical, epidemiological and etiological features. Results. – Koro is a relatively rare syndrome that is related to various etiological, clinical, diagnostic and cultural aspects leading to several controversial debates, letters to editors and comments on articles. This also includes the anthropological, psychodynamic and biological point of views. Even though only 19 cases in Hong Kong were diagnosed in fifteen years, this syndrome can sometimes take epidemic proportions as in Singapore where many cases appeared following a porcine infection or in Thailand where a thousand cases were listed after the Vietnam War. In the province of Juandong, two similar phenomena were clearly documented in 1984–1985 and 1987 where a total of two thousand cases were declared. This was also observed in India, a country culturally very different with a mainly Hindu and Muslim population. The authors also describe six cases in Quebec: 1- a 31-year-old man with no history of psychosis with anxiety related to problems in erection and ejaculation that had negative effects on his married life. Shortly after he reported that his penis retracted into his belly. 2- a 32-year-old American-Indian man, with history of violence and alcohol dependence developed Koro symptoms, which caused this patient to use strings around the penis to prevent its retraction into the belly. 3- an 18-year-old male diagnosed with paranoid schizophrenia expressed his extreme concern to see his penis decrease in size and retract during one of his hospitalisations. He believed that only masturbation and sex with prostitutes were capable of preventing this from happening. 4- a 25-year-old patient diagnosed with paranoid schizophrenia since the age of 16 arrived at the emergency with suicidal ideas. Upon interview, the patient was anxious and presented olfactory hallucinations of genital origin. He expressed concerns that his genitals would disappear inside his abdomen. 5- a 25-year-old man with paranoid schizophrenia presented with auditory hallucinations of death threats and fear that his penis would be removed by magic. After one month of hospitalisation, his anguish took an obsessive form that required him to go to the bathroom regularly to examine himself. 6- a 31-year-old man diagnosed with paranoid schizophrenia since the age of 19 arrived at the emergency with suicidal ideations under the influence of command hallucinations. He requested a treatment that would prevent his genitals from disappearing into his belly. Conclusion. – A distinction seems necessary between epidemic cases of Koro that are culture-specific and isolated cases, that given the right setting and stimulus could occur in any culture and are often present in comorbidity with severe psychopathologies or cerebral lesions. [Copyright &y& Elsevier]