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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]

Le microbiote vaginal joue un rôle capital dans la santé d'une femme et représente une barrière de défense contre les vaginoses et les infections sexuellement transmissibles (IST). Cependant, les données sur ce microbiote restent peu documentées, alors que ses modifications constituent un problème de santé publique. Dans cette revue, nous avons voulu évaluer l'impact du mode ou des habitudes de vie de la femme sur le microbiote vaginal documenté par des approches en métagénomique. Dans ce cadre, l'hygiène personnelle, les comportements sexuels, les moyens de contraception, le tabagisme, la consommation d'alcool et le stress psychosocial ont été analysés. Le rôle des Lactobacillus est essentiel, représentant une première ligne de défense face aux micro-organismes pathogènes. Le déséquilibre du microbiote avec une augmentation de la diversité bactérienne et/ou la raréfaction des Lactobacillus représente un facteur clé dans l'évolution vers les pathologies infectieuses vaginales. Nous avons observé que la contraception hormonale et l'hygiène personnelle augmentent la présence des Lactobacillus favorisant la stabilité du microbiote vaginal, alors que certains comportements sexuels, le tabagisme, la consommation d'alcool, les règles et le stress étaient associés à une dysbiose et à un risque accru de vaginose bactérienne, IST et maladies inflammatoires pelviennes sévères. L'origine ethnique représentait un facteur de confusion dans toutes les études, en raison du microbiote vaginal instable observé dans certaines populations (africaine ou afro-américaine). Une connaissance approfondie de ces modifications du microbiote vaginal est nécessaire pour mieux prendre en charge la santé des femmes. The vaginal microbiota plays a crucial role in a women health, and serves as a defense barrier against vaginoses and sexually transmitted infections (STIs). However, data on this microbiota remain poorly documented, despite changes in the vaginal microbiote being a public vaginal modification constituting a public health concern. In this review, we investigated the impact of woman lifestyle or habits on the vaginal microbiota documented through metagenomic approaches. In this context, personal hygiene, sexual behaviors, hormonal contraception, smoking, alcohol consumption and psychosocial stress were analyzed. Lactobacillus played a key role, representing a first line of defense against pathogenic microorganisms. The imbalance of the microbiota with an increase in bacterial diversity and/or the rarefaction of Lactobacillus is a key factor in the progression towards vaginal infectious pathologies.We observed that hormonal contraception and personal hygiene increased the presence of Lactobacillus promoting stability in the vaginal microbiota while certain sexual behaviors, smoking, alcohol consumption, menstruation and psychosocial stress were associated with dysbiosis and an increased risk of bacterial vaginosis, STIs, and severe pelvic inflammatory diseases. Ethnicity represented a confounding factor in all studies, due to the unstable vaginal microbiota detected in some populations (african or afro-american). A better understanding of these factors influencing the vaginal microbiota is necessary for better women's helath management. [ABSTRACT FROM AUTHOR]

Des malades atteints d'alcoolisme et de toxicomanie furent aussi soignés à Ivry par Achille Delmas. Il manifestait vis-à-vis de ces malades une attitude bienveillante et compatissante qui n'était pas orientée vers la recherche à tout prix du sevrage, comme son élève et porte-parole, le Dr Itzko Bussel, l'exposa dans sa thèse. Le séjour de Maurice Utrillo fut bénéfique car il interrompit une longue série d'hospitalisations sous contrainte dues à des ivresses délirantes. En revanche, Roger Gilbert-Lecomte, atteint d'une grave toxicomanie aux opiacés, sombra après sa sortie dans une déchéance bientôt fatale. Le séjour d'Antonin Artaud est détaillé et un parallèle est dressé entre les soins qui lui furent dispensés lors de son séjour à Rodez par Gaston Ferdière et l'attitude complaisante que Delmas manifesta à son égard. Achille Delmas also treated patients affected by alcoholism and drug addiction at the "maison de santé d'Ivry". As his student Itzko Bussel explained in his thesis, Delmas showed his patients a kindly and compassionate demeanor and did not seek to wean them off their drug at all cost. Maurice Utrillo's stay at the facility was beneficial as it ended a long series of forced hospitalizations due to delirious drunkenness. By contrast, Roger Gilbert-Lecomte, who was affected by a severe addiction to opium-containing drugs, sank into a fatal decay after his stay. Antonin Artaud's stay is detailed and a parallel is drawn between the care given to him in Rodez by Dr Gaston Ferdière and Dr Delmas' more indulgent attitude. [ABSTRACT FROM AUTHOR]

Les Alcooliques anonymes s'avèrent une aide à de nombreuses personnes alcoolo-dépendantes mais restent controversés de par leur approche spirituelle. Il est peu probable que la seule approche spirituelle permette à tant de personnes de rester abstinentes et des mécanismes cognitivo-comportementaux, sociaux et motivationnels ont été avancés. La présente étude illustre dans un premier temps les parallèles entre les mécanismes en œuvre aux Alcooliques anonymes et les processus de changement tel que décrits dans le modèle transthéorique du changement. Ensuite, elle étudie à l'aide d'un questionnaire les mécanismes cognitivo-comportementaux, sociaux et motivationnels auprès d'une population de personnes abstinentes aux AA et met en évidence une amélioration thymique, des changements dans la gestion de l'affectivité négative et des relations interpersonnelles, une augmentation de l'auto-efficacité et des modifications de l'entourage social. Alcoholics anonymous is a widespread mutual help group, which has helped many alcoholics to stay abstinent, but remains controversial due to the spiritual nature of its program. However, it is unlikely that the success of alcoholics anonymous in helping people with alcohol-related disorder remain sober is due solely to spiritual principles. Hence, the aim of the current study was to show that alcoholics anonymous mutual help groups activate mechanisms of action similar to those in cognitive-behavioral therapy and motivational interviewing. First, parallels were established between the transtheoretical model of change and the program of alcoholics anonymous to illustrate the mechanisms by which this mutual help group potentiates cognitive and behavioral changes in people with alcohol-related disorder. Then a questionnaire was used to investigate cognitive and behavioral mechanisms as well as social changes and modifications to depressive and anxious symptoms, in a sample of sober members of alcoholics anonymous. Results show a notable improvement in the participants' anxious and depressive symptomatology. In addition, positive changes to the management of negative affect and the management of personal relations were found. The self-efficacy score in this population was higher than that reported in previous studies, which suggests that members of alcoholics anonymous develop high self-efficacy, which can partly be explained by the cognitive, behavioral and social changes generated by the alcoholics' anonymous program. Changes in the composition of the social environment were observed and showed an increase in the number of close friends as well as an increase in the number of abstinent people in the social circle of the participants in this sample. This study shows that cognitive, behavioral and social factors contribute to the success of alcoholics anonymous in helping people with alcohol-related disorder stay sober. Hence, alcoholics anonymous mutual help groups can constitute a helpful addition to the maintenance of abstinence in individuals with alcohol-related disorder, during but especially, after professional treatment is completed. [ABSTRACT FROM AUTHOR]

L'anémie sidéroblastique est une cause rare d'anémie microcytaire, caractérisée par la présence de sidéroblastes en couronne au myélogramme. Cette anémie peut être congénitale ou bien acquise, due à une myélodysplasie ou favorisée par des carences, des médicaments et des toxiques. Nous rapportons le cas d'un homme alcoolique de 49 ans présentant une anémie microcytaire sidéroblastique sévère reliée à une carence en pyridoxine (vitamine B6). Il a aussi été identifié une carence en folates. L'hémogramme s'est corrigé en un mois avec une supplémentation vitaminique. Chez les sujets à risque, une carence en pyridoxine doit être évoquée devant une anémie sidéroblastique. Sideroblastic anemia is a rare cause of microcytic anemia, which is characterized by ring sideroblasts on bone marrow aspirate. This anemia can be congenital or acquired. We report the case of an alcoholic 49-year-old man who presented with a severe microcytic sideroblastic anemia related to pyridoxine (B6 vitamin) deficiency. Acid folic deficiency was associated. The blood count normalized within one month after vitamin supplementation. Pyridoxine deficiency must be sought in sideroblastic anemia in patients at risk. [ABSTRACT FROM AUTHOR]

Évaluer les attitudes de médecins et infirmiers hospitaliers envers des aînés mésusant d'alcool. Alors que ce mésusage persiste après 65 ans, la souffrance induite est peu considérée : peut-on relier cette apparente négligence à des contre-attitudes négatives ? Enquête par entretiens auprès d'infirmiers et de médecins, analyse des discours par le logiciel Alceste®. L'analyse de 45 entretiens menés à 69 % auprès de femmes et 58 % d'infirmiers, a fait émerger : la perception d'un caractère moins menaçant des aînés alcoolisés, le recours à l'humour dès que l'alcool est évoqué, la négation du manque de temps ou de formation pour les soins, et des effets favorables d'expériences en alcoologie. Les attitudes soignantes à propos d'aînés mésusant d'alcool apparaissent moins négatives qu'attendu selon la littérature, laissant une place pour des soins entre addictologie et gérontologie. While alcohol misuse remains over 65-age bracket, but the induced suffering is often overlooked. Is it possible to link this apparent neglect to negative counter-attitudes on the caregivers' part? To evaluate the nursing attitudes of doctors and hospital nurses towards elderly who misuse of alcohol, while old age and alcohol misuse are only rarely considered together. When the prevalence of alcohol use disorder is located around 10% in the over 65 age bracket and such situations are encountered daily by hospital or nursing-home caregivers. Is it possible to consider this apparent neglect as a translation of negative counter-attitudes on the caregivers' part? A cross-sectional surveys by means of research interviews, were conducted among the nurses and the physicians working in 8 health facilities around Macon. The main objective was to approach the feelings, beliefs and attitudes of caregivers with older individuals who misuse alcohol. These variables were observed according to several socio-professional criteria. The interviews were recorded and the dialogue was processed both manually and by Alceste® software. The 45 research interviews were conducted with 16 physicians and 29 nurses, of whom 69% were women. Discourses analysis has highlighted some specific extracts out of them: a less threatening perception of alcoholized elderly individual, the use of humor appearing specifically when alcohol is mentioned and questioning about a lack of time or training for such care. The interviews allowed the highlighting of negative feelings and emotions and also emphasized the important role and the favorable impact of familiar experiences with sufferers of alcohol misuse in the life of the care provider. Such favorable effects of having had a life experience close to a familiar person misusing of alcohol, as a work experience in alcohology are highlighted. Despite the limitations of the lack of focus groups, this study confirms the significant frequency with which caregivers come into care situations with elderly individuals misusing alcohol. This point calls into question the ignorance which surrounds these situations which helps us to better understand their negligence and which may explain the small percentage of skilled addictological help given to the elderly person after early screening. The classical allegation of lack of time or knowledge (and training) seems to be contradicted. These claims can be caregivers' defensive rationalizations concerning situations experienced as difficult. The question of denial may be considered in the same way: often referred to without being wary of its repercussion. Caregivers' attitudes about the elderly misusing alcohol appear to be variable, multifaceted, complex, being neither good nor bad. Beyond the phenomenology of attitude, there is the consideration of internal elements of the caregivers' thinking and those cared for which undergird care providers' behavior. This approach seeks to promote a psychodynamic regard on the elderly who misuse alcohol trough the care-givers approach. [ABSTRACT FROM AUTHOR]

Résumé L’exploration biochimique du foie est particulièrement importante étant donné ses fonctions de synthèse, de stockage, d’élimination et de transformation de molécules biologiques. L’exploration des fonctions excréto-biliaires passe par les dosages sériques des différentes formes de la bilirubine, des acides biliaires, des enzymes PAL, GGT et 5’-Nuc. Elle est utile au diagnostic d’une cholestase et à la classification des ictères. Les fonctions de synthèse du foie sont explorées par le dosage de l’albumine et la réalisation de tests d’hémostase, qui jugeront du degré d’insuffisance hépatique. Le foie a aussi d’importantes fonctions d’épuration qui pourront être étudiées par le dosage de l’ammoniémie et la réalisation de tests d’épuration comme à la BSP ou à l’ICG. La cytolyse hépatique est classiquement étudiée par la mesure d’enzymes plasmatiques comme les transaminases (ASAT et ALAT), la LDH et ses iso-enzymes, la GLDH ou encore l’α-GST. L’inflammation est étudiée par la mesure de la VS et l’électrophorèse des protéines sériques. La fibrose hépatique bénéficie de dosages de protéines de la matrice extracellulaire, souvent présentés sous forme de scores de fibrose. La détection de l’alcoolisme s’est aussi améliorée par de nouvelles approches avec le test CDT (« Carbohydrate Deficiency Transferrin »), plus spécifique que l’augmentation du « volume globulaire moyen » (VGM) et de l’activité de la « Gamma-Glutamyl-Transpeptidase » (GGT). Summary Biochemistry of the liver is particularly relevant because liver exerts many important functions such as synthesis, stocking, elimination and transformation of biomolecules. The biochemical exploration of bile secretion needs the determination in serum of various bilirubin forms, bile acids, and enzymes such as PAL, GGT and 5’-Nuc, all of them being useful for the diagnosis of cholestasis and to the classification of icterus. The functions of the liver are explored by the dosage of both albumin and hemostasis factors reflecting the level of liver failure. The liver exerts also important purification functions which can be explored by the determination of ammonium, and the realization of BSP or ICG tests. Liver cytolysis is classically studied by transaminases (SGOT and SGPT), LDH and its iso-enzymes, GLDH and even α-GST. Inflammation is studied with the measure of the sedimentation rate and the electrophoresis analysis of serum proteins. Liver fibrosis has now the benefit of the dosages of proteins from the extracellular matrix, often gathered in fibrosis scores. The detection of alcoholism is easier with the development of CDT test (« Carbohydrate Deficiency Transferrin »), more specific than the elevated « Mean Corpuscular Volume » (MCV) and the « Gamma-Glutamyl-Transpeptidase » (GGT) activity. [ABSTRACT FROM AUTHOR]

Résumé Les conduites alcooliques sont fréquentes chez les sujets jeunes et en particulier chez les étudiants qui sont plus exposés aux changements sociaux et économiques. Cependant, les études en Tunisie restent peu nombreuses. Les objectifs de notre étude étaient d’étudier la prévalence des conduites alcooliques et d’en préciser les caractéristiques sociodémographiques et cliniques associées chez un groupe d’étudiants infirmiers. Matériel et méthode Nous avons mené notre étude auprès de 266 étudiants inscrits à l’Institut supérieur de sciences infirmières de Sousse durant une période de trois mois. Nous avons administré auprès d’eux un questionnaire anonyme explorant les caractéristiques sociodémographiques et cliniques. De même, nous avons passé à ces étudiants l’Alcohol Use Disorders Identification Test (AUDIT) afin de dépister leurs conduites alcooliques. Résultats Le score moyen à l’AUDIT était de 3,5 ± 2,7. Une consommation à risque était retrouvée dans 12 % des cas et une dépendance dans 11,7 %. Les facteurs associés aux conduites alcooliques étaient : l’âge ( p = 0,026), le sexe masculin ( p < 10 −3 ), les antécédents de redoublement ( p = 0,029) et les antécédents de troubles anxieux et dépressifs ( p = 0,002). Conclusion La prévalence de la dépendance alcoolique est de 12 %. La prévention des conduites alcooliques chez les étudiants doit passer par des programmes de prévention afin de mieux sensibiliser nos jeunes des risques néfastes de l’alcool. Alcohol behavior is common in young people and especially among students who are more vulnerable to social and economic changes. However, studies in Tunisia remain few. Objectives The aims of our study were to investigate the prevalence of alcohol and to assess sociodemographic and clinical associated factors in a group of nursing students. Materials and methods We conducted this study with 266 students enrolled at the Higher Institute of Nursing Sousse for a period of 3 months. We administered to them an anonymous questionnaire exploring the sociodemographic and clinical characteristics. To explore their alcohol behavior, we used Alcohol Use Disorders Identification Test (AUDIT). It is an instrument frequently used in international studies, it evaluated alcohol behavior in the last 12 months. Subjects with an AUDIT score above 13 are alcohol-dependent. Results The mean AUDIT score was 3.5 ± 2.7. Alcoholic consumption risk was found in 12 % of cases and 11.7 % of nurse students were dependant. Associated factors statistically correlated with high alcohol consumption were age ( r = 0.13; P = 0.026), male gender ( P < 10 −3 ), university repeating ( P = 0.029) and past history of personal depressive disorders ( P = 0.002). Conclusions The prevalence of alcohol dependence in nurse students was 12 %. Factors associated with high alcohol consumption were age, male gender, university repeating and past history of personal depressive disorders. Prevention of alcoholic behavior among students needs to develop adapted prevention programs to better educate them against the harmful risks of alcohol. [ABSTRACT FROM AUTHOR]

Résumé Le peintre français Maurice Utrillo (1883–1955) a été hospitalisé plusieurs fois dans des asiles d’aliénés entre 1904 et 1921. Il souffrait d’alcoolisme grave et peut-être de schizophrénie. En 1921, il est inculpé pour outrage public à la pudeur. Il est alors expertisé par le célèbre aliéniste Gaétan Gatian de Clérambault (1872–1934) qui le reconnaît irresponsable de son acte et demande qu’il soit réhospitalisé en psychiatrie. Les auteurs publient le texte original de ce rapport psychiatrique qu’ils critiquent sur la forme (fautes répétées de grammaire et de syntaxe) et sur le fond (examen mental incomplet et superficiel). The French painter Maurice Utrillo (1883–1955) was hospitalized several times in lunatic asylums between 1904 and 1921. He suffured from severe alcoholism and perhaps schizophrenia. In 1921, he was charged with indecent exposure. He was then appraised by the famous psychiatrist Gaétan Gatian de Clérambault (1872–1934) who recognized him as being irresponsible of his act and requested a re-hospitalization. The authors publish the original text of his expert's report, of which they criticize the form (repeated mistakes of grammar and syntax) and substance (incomplete and superficial mental examination). [ABSTRACT FROM AUTHOR]

Résumé En dehors de la cancérologie et de l’infectiologie, d’autres secteurs bénéficient de l’arrivée de médicaments à principes actifs nouveaux. C’est le cas de la gynécologie, de la pneumologie, de la toxicologie et de l’urologie. Ces spécialités offrent des perspectives innovantes, même si l’amélioration du service médical rendu n’est pas optimale. Summary Aside from oncology and infectiology, other sectors are also benefiting from the arrival of drugs with new active ingredients, including gynaecology, pneumology, toxicology and urology. These specialities offer innovative perspectives, even if the improvement in the medical benefit is not optimal. [ABSTRACT FROM AUTHOR]

Résumé La découverte d’une hyperferritinémie est le plus souvent fortuite. La démarche diagnostique a pour but de rechercher l’étiologie responsable et de vérifier s’il existe ou non une surcharge hépatique en fer. Trois étapes sont proposées. Les éléments cliniques et quelques examens biologiques simples sont suffisants dans un premier temps pour déceler une des quatre causes les plus fréquentes : alcoolisme, syndrome inflammatoire, cytolyse, syndrome métabolique. Aucune de ces causes ne s’accompagne d’une surcharge hépatique en fer importante. S’il existe un coefficient de saturation élevé (> 50 %), une hémochromatose héréditaire sera évoquée en priorité. Dans un deuxième temps, des pathologies plus rares seront recherchées. Parmi celles-ci, seules les pathologies hématologiques chroniques, acquises ou congénitales, sont à risque de surcharge hépatique en fer. Dans un troisième temps, si un doute persiste dans la recherche étiologique, que la ferritinémie est très élevée ou continue à s’élever, il est indispensable de vérifier qu’il n’existe pas une surcharge hépatique en fer. Pour cela, l’IRM avec étude de la charge en fer est l’examen principal qui guidera l’attitude thérapeutique. La découverte d’une cause ne doit pas faire oublier que plusieurs causes sont associées dans plus de 40 % des cas. The discovery of a hyperferritinemia is most of the time fortuitous. The diagnostic approach aims at looking for the responsible etiology and at verifying if an iron hepatic overload is present or not. Three diagnostic steps are proposed. The clinical elements and a few straightforward biological tests are sufficient at first to identify one of the four main causes: alcoholism, inflammatory syndrome, cytolysis, and metabolic syndrome. None of these causes is associated with a significant iron hepatic overload. If the transferring saturation coefficient is raised (> 50%) a hereditary hemochromatosis should be discussed. Secondly, less common disorders will be discussed. Among these, only the chronic hematological disorders either acquired or congenital are at risk of iron hepatic overload. Thirdly, if a doubt persists in the etiologic research, and the serum ferritin level is very high or continues to rise, it is essential to verify that there is no iron hepatic overload. For that purpose, the MRI with study of the iron overload is the main test, which will guide the therapeutic attitude. Identification of more than a single etiology occurs in more than 40% of the cases. [ABSTRACT FROM AUTHOR]

Résumé Les progrès techniques et la disponibilité des outils de neuroimagerie ont permis une avancée sur la caractérisation des effets de l’exposition chronique et excessive d’alcool sur le cerveau humain. La consommation d’alcool à long terme modifie le cerveau, et ces changements peuvent contribuer au maintien de la dépendance. Il est donc difficile de distinguer les causes des effets des troubles liés à la prise d’alcool. La dépendance à l’alcool suit un parcours longitudinal, dès le début du développement de la dépendance, de la consommation chronique, jusqu’au sevrage, en passant souvent par la rechute. La disponibilité des outils d’imagerie a permis, par exemple, de révéler des déficits de volume répandus dans la substance grise et la substance blanche avec une prédilection pour le cortex préfrontal. Ces altérations structurales sont en lien avec des déficits cognitifs qui sont eux-mêmes fortement liés aux difficultés du maintien du sevrage. Alcohol dependence follows a longitudinal course, from initiation to development of dependence, chronic intake, withdrawal, and often relapse. Advances in MRI technologies have enabled exploration of brain changes for each of these steps and, for example, has revealed widespread volume deficits in gray and white matter with a predilection for the prefrontal cortex. These structural changes are related to cognitive deficits that are themselves highly related to the difficulties of maintaining cessation. The technical advances and the availability of neuroimaging tools has allowed progress on the characterization of the effects of chronic and excessive alcohol on the human brain. Long-term alcohol consumption changes the brain and these changes may contribute to the maintenance of dependency. It is therefore difficult to distinguish causes from effects related to the use of alcohol disorders. [ABSTRACT FROM AUTHOR]

Résumé L’objectif de cette revue de la littérature est d’introduire, présenter et analyser le phénomène clinique de la codépendance. Elle présentera les modèles explicatifs, les outils de mesure et les stratégies thérapeutiques pour terminer par une analyse critique du concept et de son utilisation. La codépendance est une entité qui s’exprime à travers quelques symptômes majeurs tels que le déni, l’hyper-contrôle, la répression émotionnelle, les compulsions, la négligence de soi et une difficulté à définir des limites saines. Elle est évaluée par un outil valide et fiable qui est le Codependency Assessment Tool (CODAT). Au niveau thérapeutique, les spécialistes mettent l’accent sur l’importance du diagnostic pré-thérapeutique, sur le développement de stratégies thérapeutiques ciblées et sur les bénéfices d’un suivi à la fois individuel et groupal. Au niveau collectif, ce sont notamment les programmes en 12 étapes, tel que Al-Anon ou Codépendants Anonymes, qui proposent des groupes de parole adaptés à cette symptomatologie bien qu’ils insistent sur des limites qu’il est important de connaître. Malgré un intérêt pour ce concept du fait de son utilité clinique et de sa résonance chez certains patients qui en sont porteurs, certains auteurs soulèvent l’existence de failles conceptuelles ainsi que des données empiriques insuffisantes. La recherche exploratoire sur le phénomène et ses manifestations doit ainsi continuer. The goal of this literature review is to introduce, present and analyze the clinical phenomenon that is codependency. It will present explanatory models, measurement tools and therapeutic strategies, before introducing a critical analysis of this concept and its use. Codependency is an entity defined by several major symptoms such as denial, hyper-control, emotional repression, compulsions, self-neglect and a difficulty setting healthy boundaries. It is evaluated with a valid and reliable tool, called the Codependency Assessment Tool (CODAT). On a therapeutic level, specialists underline the importance of a pre-therapeutic diagnosis and the development of targeted therapeutic strategies. They also emphasize the benefits of combined individual and group therapy. On a collective level, 12 step programs, such as Al-Anon and Codependents Anonymous, offer support groups adapted to these symptoms although they insist on certain limits that must be understood. Despite an interest for this concept because of its clinical usefulness and its resonance with certain patients that suffer from it, certain authors mention conceptual flaws and insufficient empirical data. Thus, exploratory research concerning this phenomenon and its effects must continue. [ABSTRACT FROM AUTHOR]

Résumé: Une élévation modérée, persistante et mal expliquée des transaminases sériques doit faire évoquer en premier lieu une souffrance hépatique d’origine métabolique, situation très fréquente actuellement (surcharge pondérale, syndrome métabolique, alcoolisme, diabète), une infection virale, et une toxicité médicamenteuse. Avant de rechercher des maladies hépatiques ou génétiques plus rares, il faut évoquer systématiquement une origine musculaire, en particulier chez l’enfant, ce qui nécessite le dosage de la créatine phosphokinase sérique. Ensuite, les données anamnestiques, l’examen physique et surtout des explorations biologiques appropriées vont permettre d’identifier des maladies moins fréquentes mais dont une hypertransaminasémie isolée persistante peut constituer le seul indice de façon prolongée : hémochromatose, maladie cœliaque, hépatite auto-immune, maladie de Wilson, déficit en α1-antitrypsine, dysthyroïdie, insuffisance surrénalienne. Une biopsie hépatique ne paraît justifiée que devant la persistance d’aspartate aminotransférases élevées ou d’alanine aminotransférases supérieures à deux fois la normale après une période de six mois comportant des corrections hygiénodiététiques. [ABSTRACT FROM AUTHOR]

Résumé: S’il est pertinent de différencier l’alcoolisme chez l’homme et chez la femme au niveau médical, comportemental, social et culturel, les auteurs soutiendront dans cet article une approche psychanalytique indépendante du genre. Ils insisteront sur l’existence d’un fantasme pathogène précoce d’encombrant construit par l’alcoolique et pour l’alcoolique par l’Autre. L’alcoolique n’aurait pu trouver une légitimité d’existence dans une nomination symbolique le distinguant de son double dans le miroir, il se vivrait comme un encombrant et aurait été pensé comme tel par les instances parentales. Dans ce contexte anxiogène, le fantasme d’encombrant conduirait à l’instauration des relations sado-masochistes qui n’aideraient pas l’alcoolique à penser la séparation puis sa place de sujet sexué. Il resterait enkysté dans des liens métonymiques (pseudo-liens de fraternité dans l’alcoolisme de comptoir) qui relèvent d’une quête de l’identique ou encore d’une adhésion plaquée à des conventions sociales (un homme ça boit). De plus, par cette réification du sujet en encombrant, les hommes comme les femmes alcooliques supporteraient mieux leur souffrance. Leur espoir serait d’être enfin un jour reconnus sans avoir à être encombré par l’Autre ou sans avoir à encombrer l’Autre pour exister. [ABSTRACT FROM AUTHOR]

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Abstract: Drawing on the story of events surrounding the hospitalization of a patient named Mr. B., the authors try to reconstruct what, from the non-symbolized past of this patient, is going to be replayed during this regressive period. Observation and decoding of the institutional mise-en-scene that the patient evokes in the hospital environment do reveal him as a “user” of the place he uses, often without him knowing, by producing a singular reconfiguration of what is established and constituted as a template for welcome and care. Consequently, the authors review this reconfiguration of the medical institution through observation of various times when a specific interactive dynamics is put into effect between the patient and the other patients but also with the nursing body and its hierarchy. They suggest the idea of deploying a primary fantasy scenario peculiar to the patient and perceptible in the movements and feelings of the professionals, in the actions of this patient and in his statements during dual conversations. The known traumatic elements of the patient''s life are put into correspondence with the scenes produced in the institutional space. These mappings show how the hospital can be the theater of a simple repetition of the traumatisms or become a convenient space for their partial elaboration. [Copyright &y& Elsevier]

Abstract: Alcoholic hepatitis is one of the most severe presentations of alcoholic liver disease. It is usually revealed by the recent onset of jaundice in a patient with alcoholic cirrhosis. Maddrey''s discriminant function can help to recognize patients with poor prognosis (the 6-month mortality is above 50% when it exceeds 32). Corticosteroids increase survival in those patients with high risk of death. Other treatments (pentoxifylline, N-acetyl-cysteine or enteral nutrition) need to be investigated further before to recommend their routine use instead of, or in association with, corticoids. Liver transplantation can be proposed to highly selected patients who do not respond to medical therapy. In any case, long-term prognosis will primarily depend on the maintenance of alcohol abstinence. [Copyright &y& Elsevier]

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Summary: Alcohol dependence constitutes a serious worldwide public health problem. The last few decades have seen many pharmacological studies devoted to the improvement of alcoholism treatment. Although psychosocial treatments (e.g. individual or group therapy) have historically been the mainstay of alcoholism treatment, a successful approach for alcohol dependence consists in associating pharmacologic medications with therapy, as 40–70% of patients following only psychosocial therapy typically resume alcohol use within a year of post-detoxification treatment. Nowadays, two main pharmacological options, naltrexone and acomprosate, both approved by the US Food and Drug Administration, are available and seemingly improve on the results yielded by standard techniques employed in the management of alcoholism. However, insufficient data exist to confirm the superiority of one drug over the other, and research is ongoing to determine what type of alcohol-dependent individual benefits the most from using either medication. Available data on the application of both drugs clearly suggest different practical applications. Thus, a fundamental question remains as to how we can identify which alcoholic patients are likely to benefit from the use of naltrexone, acamprosate or both, and which are not. The aim of the present manuscript is to suggest the use of cognitive event-related potentials as an interesting way to identify subgroups of alcoholic patients displaying specific clinical symptoms and cognitive disturbances. We propose that this may help clinicians improve their treatment of alcoholic patients by focusing therapy on individual cognitive disturbances, and by adapting the pharmaceutical approach to the specific needs of the patient. [Copyright &y& Elsevier]

Abstract: The alcoholic subject is described as an “unable to keep his word” being who would tell a lot of stories for want of being able to build history. To explain this difficulty, we will put forward a psychoanalytical hypothesis based on a fixation-regression point at the mirror stage during the oral phase. During the latter, the separation would not have come with a true word inviting the child to use the word later on to accompany his existence. During the mirror stage, the mother''s look, which could have been perceived as “frosty”, would inhibit the child. The result would be an autoerotic mode of functioning and an inadequate working out of the libidinal links that would not enable the alcoholic to think of the right distance and build history. We will illustrate the consequences of this weakness of the structuring of the subjective experience with clinical examples and the “logical time” lacanien concept. The moment of seeing (time of the drive flash) will be worked at the level of the fixation-regression point of the mirror stage during the oral phase; the time to understand (time of transitivity) would persist with the alcoholic subject making him unable to think of the right distance; the time to conclude (moment of flash of the subject of desire) would be a difficult time with the alcoholic owing to his difficulty to set a speech act and build history. [Copyright &y& Elsevier]

Abstract: Exploratory hypothesis: The representation of the mother among treated alcoholic women is specific and different from the mother''s representation among non-alcoholic women. Methodology: The present study involved 10 alcoholic women and 10 non-alcoholic women. The participants’ maternal representation, the level of dependency to alcohol and psychiatric comorbid disorders were assessed in both groups using the Thematic Apperception Test (TAT), the Alcohol Use Disorders Identification Test (AUDIT) and the Mini International Neuropsychiatric Interview (MINI). Results: The mother''s representation was found invading and intrusive among alcoholic women. A significant correlation between alcohol dependency and depression was evidenced. Conclusion: The mother seems omnipresent in the alcoholic woman''s psychological life. Alcoholic women seem to experience unsatisfying relationships with their mother and to perceive them as omnipotent. Dependency to alcohol could be an answer to this specific type of relationship. Before being generalised and included in the existing treatment programs, these findings should be confirmed by further studies using a wider sample size. [Copyright &y& Elsevier]

Abstract: The present paper reports the results of an open 3-month trial of baclofen for the treatment of alcohol dependence. Baclofen was prescribed at escalating dose, with 300mg/day as set upper limit, up to the point at which patients experienced a decrease or a suppression of their motivation to drink. The results show that, at 3months, 88% of the patients had either totally stopped drinking, or had significantly decreased their alcohol intake and that many of them had become indifferent to alcohol, effortlessly. Efficacious doses were highly variable from patient to patient, ranging from 15mg/day to 300mg/day (average 145mg/day). Approximatelaly 2/3 of the patients needed a dose higher than the approved 80mg/day dose. [Copyright &y& Elsevier]

Summary: Introduction: Increasing knowledge of the anatomical structures and cellular processes underlying psychiatric disorders may help bridge the gap between clinical signs and basic physiological processes. Accordingly, considerable insight has been gained in recent years into a common psychiatric condition, i.e., chronic alcoholism. Material and methods: We reviewed various physiological parameters that are altered in chronic alcoholic patients compared to healthy individuals – continuous electroencephalogram, oculomotor measures, cognitive event-related potentials and event-related oscillations – to identify links between these physiological parameters, altered cognitive processes and specific clinical symptoms. Results: Alcoholic patients display: (1) high beta and theta power in the resting electroencephalogram, suggesting hyperarousal of their central nervous system; (2) abnormalities in smooth pursuit eye movements, in saccadic inhibition during antisaccade tasks, and in prepulse inhibition, suggesting disturbed attention modulation and abnormal patterns of prefrontal activation that may stem from the same prefrontal “inhibitory” cortical dysfunction; (3) decreased amplitude for cognitive event-related potentials situated along the continuum of information-processing, suggesting that alcoholism is associated with neurophysiological deficits at the level of the sensory cortex and not only disturbances involving associative cortices and limbic structures; and (4) decreased theta, gamma and delta oscillations, suggesting cognitive disinhibition at a functional level. Discussion: The heterogeneity of alcoholic disorders in terms of symptomatology, course and outcome is the result of various pathophysiological processes that physiological parameters may help to define. These alterations may be related to precise cognitive processes that could be easily monitored neurophysiologically in order to create more homogeneous subgroups of alcoholic individuals. [Copyright &y& Elsevier]

Abstract: Notion of alcoholic disease goes back to about half a century. Emerged from many other forms of excess in the consumption of substances or activities practices. To treat these disorders, the notion of disease is no longer relevant because considering only dependency on the substance or activity in question, it puts aside the wish and will problems. Yet, they play an important role. Hence, the relevance of the concept of addiction which can grasp of them, provided that is not overlooked the fact that the ability to decide remains unresolved in all addictions whatever the degree of dependence. [Copyright &y& Elsevier]

Summary: Launois-Bensaude syndrome is a rare pathology. The presence of multiple, symetric, non encapsulated lipomatous masses in the face, neck, upper arms and upper trunk is typical. Men are especially affected between age of 35 and 50. The disease is frequently associated with alcoholism, hepatopathy, glucose intolerance, hyperuricemia, and malignant tumors of the upper airways, requiring thorough clinical evaluation of all patients. Cosmetic deformity and compression lead patients to seek treatment. Therapy is difficult. Dietary treatment and weight loss are of limited value in the management of this pathology. Surgery is the only effective treatment. The surgeon must make sure that the patient has ceased his alcohol abuse before performing this treatment. Conventional surgery or liposuction are used to restore a normal social life to these patients, deformed by their disease. This surgical management has a severe tendency to haemorrhage, dissection is complicated by infiltrations of neighbouring tissue and is frequently followed by recurrence, mainly after liposuction. Nevertheless, based on a review of ten cases, good results of surgical removal must prompt to operate them on. [Copyright &y& Elsevier]

Abstract: The statistically positive correlation between severe mental disorders and physical violence has now been firmly established by international studies. In Europe, about 10% of homicides are committed by psychotic patients who may re-offend. Three medicolegal observations of homicides with bodily mutilation are presented. The first concerns a 31-year-old schizophrenic man who killed a passer-by in the street when in a state of paranoid delusion with themes of homosexual rape and persecution. The crime was committed in two separate phases: first, emotional violence and then, a few hours later, operational utilitarian violence with amputation of the victim''s hands. The second case concerns a 21-year-old man suffering from paranoid schizophrenia associated with an antisocial personality disorder. During the night, he assassinated two women who worked in a psychiatric unit, one of whom was decapitated while still alive. Although living freely in the community, the patient acted with premeditation and method under the influence of ideas of persecution and cosmic supernatural terror. The third case concerns a 30-year-old man who had been forcibly hospitalized in a psychiatric unit for delusional disorder of persecution with paranoiac personality disorder. During a period of weekend leave, he killed his own mother in the family home in a totally disorganized emotional moment of acting out, then cut off her leg and threw it out of the window. Six years beforehand, he had already killed a prison inmate who was sharing his cell. In the first two cases, the patients’ behavior was partially or totally organized despite delusional motives of paranoid type. In the light of these three dramas and a litterature review, the main psychopathological predictors of physical violence committed by psychotic patients are discussed: severe psychotic episode, persecutory delusional beliefs, comorbidity with substance abuse (alcohol, cannabis) and personality disorders, little or no antipsychotic treatment, and poor therapeutic compliance. In France, it appears mandatory to apply a rigorous procedure for evaluating the dangerousness of severe mental patients and violent criminals. [Copyright &y& Elsevier]

Abstract: Alcohol dependence entrains psychological, physiological and toxic factors. Anxiety, depression and other emotional disorders may be a cause or a consequence of alcohol dependence. Although alcohol is known to have anxiolytic and anti-phobic properties, alcoholic patients have a higher prevalence of developing anxiety disorders. A prevalence of panic disorders is higher in an alcoholic population and similarly alcohol dependence is higher in a population suffering from panic disorders. The association of alcohol dependence with depression in panic disorders increases suicidal risks and ideation. The prevalence of alcohol dependence is also higher in phobias and OCD. Alcohol dependence and anxiety disorders seem to be genetically associated: Anxiety disorders are greater in first degree family members of alcoholic patients. Alcohol dependence can be a cause or a consequence of anxiety disorders; simple, social phobias and agoraphobias usually precede alcoholism, while GAD occurs simultaneously with it. Depending on dose intake alcohol can reduce or increase anxiety by causing a dysfunction of the neurotransmission of GABA, glutamate and noradrenalin receptors. Alcohol intake can have euphoric or depressive effects, depending on dose intake, psychological characteristics and patients’ expectations. [Copyright &y& Elsevier]

Summary: Introduction: Alcoholism is associated with a deficit in the processing of emotional facial expressions (EFE) and with a delayed P3b component, partially mediated by earlier perceptive deficits (P100, N170). Since alcohol dependence often occurs with depression, we aim at investigating whether classical event-related potentials (ERP) alterations observed in alcoholism are modulated or not by depression. Methods: Four groups (controls; alcoholics; depressed; alcoholics-depressed) of 12 participants performed two different discrimination tasks, a gender and an emotional one. They had to decide as quickly as possible about the gender or the emotion displayed by facial stimuli during an ERP recording session (32 channels). Reaction times (RTs), P100, N100, N170 and P3b were recorded. Results: At the behavioural level, control participants discriminated EFE (but not gender) more rapidly than the three other groups. At the ERP level, the differences observed on RTs for emotional task were neurophysiologically indexed by a delayed P3b component. This delay was associated with earlier ERP alterations (P100, N100, N170), but only in participants suffering from alcohol dependence, in association or not with depression. Discussion: On the one hand, individuals with alcoholism, associated or not with a comorbid depression, were impaired in the processing of EFE. This deficit was neurophysiologically indexed by early perceptive (P100, N100, N170) and decisional (P3b) alterations. On the other hand, non-alcoholic patients with depression only exhibited P3b impairment. These results lead to potential implications concerning the usefulness of the ERP for the differential diagnosis in psychiatry, notably concerning the comorbidities in alcoholism. [Copyright &y& Elsevier]

Abstract: Purpose: Anemia in patients with alcoholic liver cirrhosis is a common issue. The diagnosis could be difficult because of the multiplicity of causes, usually associated, and specificities in the diagnostic approach. This subject has not been reviewed for almost two decades. We propose a review based upon analysis of the literature and our clinical experience. Current knowledge and key points: Because of the alcoholism and the biological consequences of the liver disease, laboratory findings, especially the mean corpuscular volume, should be interpreted with caution in the diagnostic approach. Despite these drawbacks, the diagnosis of anemia is detailed according to the usual plan: normocytic, macrocytic and microcytic anemias. Finally, we propose practical guidelines. Future prospects and projects: Further prospective studies should assess the real burden of nutritional deficiencies, easily treatable. The prognostic significance of hemolytic anemias in patients with alcoholic liver cirrhosis should be studied. [Copyright &y& Elsevier]

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Abstract: In readjustment of alcoology, widows justify their addiction by impossibility of making the mourning of their late husband. The question is then: why alcohol rather than a “traditional” mourning? To consider the question, it is noticed that mourning and alcoholism are two practical disappearance of the subject but also two methods of pleasure, beyond the pleasure principle. These widows make as for them, the choice to persecute the late one by the means of sound only point of seizure, its name. They make shame with the carriers of this name, since the memory of the husband to the children and little children and this, without the least culpability. Their behaviour without inhibition, makes us consider that a counterweight (economic) exists and that there consists, via their ethyl abandonment, in a mode of payment, being equivalent to the book of flesh of the merchant of Venice. However, if it how addiction of these widows can be considered, the reasons for which them desire the growth towards a certain influence on the late one rather than towards the acceptance of its final absence, remains at the very least enigmatic. [Copyright &y& Elsevier]

Abstract: When faced with invading pathogens that can lead to infection, patients must mount an effective and appropriate immune response. Altered immune function in patients who abuse alcohol has long been described in the medical literature. The alcohol-consuming host is particularly prone to infections in the lung, including bacterial pneumonia and tuberculosis. Over the last several decades, there has been increased interest in the immune mechanisms that underlie the increased risk of infection observed in this population. This article will review the basic immunology involved in the host response to an infection and then describe how alcohol disrupts many of these immune mechanisms. It will further provide an overview of lung infections which have been linked to alcohol abuse, and finally, it will address the evolving therapeutic approaches of the immune system that are being advanced to assist in caring for immunosuppressed hosts. [Copyright &y& Elsevier]

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Abstract: The phenomenological approach to alcoholism interestingly focuses on specific dynamics of interpersonal relationships displaying the founding of the Self from a primary “us” and its original basis in the human feast. Priorities for treatment intervention recommend to involve social setting and relationships of the patients, reaching their active participation to a motivational and long term group treatment, underlying the specific therapeutic effect of world exchanges. Biopsychosocial determination of alcoholism could be primarily based on components of interpersonal relationships. Regarding social background, drinking is one of the most famous supports for the achievement of the feast, a founding marker of present time. Taking an existential point of view, the feast appears as the heart of mankind because it presents a primary “us”, a plural state which indicates the beginning and founding of the Self from the others. During the feast, we regularly have to reach our Self from the “us” while avoiding two main dangers, drunkenness, an increase in the dizziness of upright verticality, and addiction, an opposite vertical surrender to alcohol and falling into in the alcoholic relapse, both situations imply a spatial domination and the disappearance of others. Treatment programs of alcohol addicts need to integrate the necessity of reaching the existential basic trust from the support of a group to the appropriation of the community which can be defined as an original “usness”. [Copyright &y& Elsevier]

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The cognitive event-related potentials were studied in a group of 55 alcoholic patients, paired in age and sex with a group of 18 control subjects, using a protocol oddball (visual and auditory) and a protocol VCN Go/Nogo. The N200 obtained using an auditory oddball paradigm had lower amplitude in alcoholics than in controls. A significant amplitude decrease of visual P300 was also observed in alcoholic male subjects. There was however no difference in auditory P300 between alcoholics and control subjects. Using a Go/Nogo paradigm, a significant difference on the final part of the VCN appears between alcoholic and pilot subjects. In addition, the longitudinal follow-up of the same alcoholic patients showed an electrophysiological profile that allowed dividing them into two different groups. On the initial recording (17 days after weaning), the auditory oddball P300 amplitude was significantly higher at Cz and Pz among patients who relapsed during the 3 months follow-up. The same effect appeared on the CNV protocol, where the amplitude of P300 was higher in patients who subsequently relapsed than for those who remained abstemious. Cognitive ERPs may be clinically useful to improve the prediction of risk of relapse among alcoholic patients. [Copyright &y& Elsevier]

Abstract: Disulfiram is commonly used in the treatment of alcohol dependence. It induces aversive symptoms after alcohol ingestion: the “acetaldehyde syndrome”. Most often “acetaldehyde syndrome” is moderate but severe life-threatening symptoms may occur in specific circumstances. We report the case of a serious “acetaldehyde syndrome” with shock compounded by the initial administration of dopamine. Discussion clarifies the pathophysiology and develops the therapeutic management. [Copyright &y& Elsevier]

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