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Cet entretien se propose de cerner les avancées spécifiques de l'Hôpital Henri-Rousselle au moment de sa direction par le Docteur Georges Daumézon, au cours des années 1970. Le témoignage de Jean-Michel Gentizon, Assistant de l'Hôpital Henri-Rousselle entre 1972 et 1976, permet, en situant le contexte historique par le biais des ouvrages influents de cette période, de cerner progressivement les enjeux et les conséquences sur la psychiatrie française de l'action de Georges Daumézon. La politique d'ouverture aux différents champs de la psychiatrie prônée par Georges Daumézon à l'Hôpital Henri-Rousselle permet d'en cerner la fonction essentielle pour la psychiatrie française des années 1970. Cette institution se révèle une plaque tournante particulièrement novatrice, sollicitant les interventions des grandes figures de la psychiatrie de cette période. Son influence concerne la politique de secteur, le mouvement de la psychothérapie institutionnelle, le domaine de la recherche clinique et les conséquences politiques générales de cette action. L'entretien dans sa conclusion interroge l'évolution actuelle de la psychiatrie, des modalités d'ouverture moins favorables dans les décennies suivantes, d'un moindre dialogue entre les différents courants et les risques d'un rétrécissement plus récent des champs actuels de la recherche aux seules neurosciences. L'expérience de l'Hôpital Henri-Rousselle telle qu'elle a pu être développée par le Docteur Georges Daumézon, se révèle une illustration particulièrement favorable d'une politique d'ouverture de la psychiatrie aux différents courants de son époque comme aux différents registres des sciences humaines. This interview aims to identify the specific advances of Henri-Rousselle Hospital at the time of its direction by Doctor Georges Daumézon, during the 1970s. The testimony of Jean-Michel Gentizon, Assistant at Henri-Rousselle Hospital between 1972 and 1976, which situates the historical context through the influential works of this period, allows us to progressively identify the stakes and the consequences of Georges Daumézon's action on French psychiatry. The policy of opening up to the different fields of psychiatry advocated by Georges Daumézon at Henri-Rousselle Hospital allows us to identify its essential function for French psychiatry in the 1970s. This institution proved to be a particularly innovative hub, soliciting the interventions of the great figures of psychiatry of this period. Its influence concerns the policy of the sector, the institutional psychotherapy movement, the field of clinical research, and the general political consequences of this action. The interview in its conclusion questions the current evolution of psychiatry, the less favorable opening modalities in the following decades, a lesser dialogue between the different currents, and the risks of a more recent narrowing of the current fields of research to the neurosciences alone. The experience of Henri-Rousselle Hospital, as developed by Dr. Georges Daumézon, proves to be a particularly favorable illustration of a policy of opening up psychiatry to the different currents of its time as well as to the different registers of the human sciences. [ABSTRACT FROM AUTHOR]

(i) Retracer la genèse des consultations thérapeutiques parents/bébé et en pointer les carrefours épistémologiques ; (ii) Présenter les résultats principaux d'une recherche effectuée à l'hôpital Necker dans une consultation parents/bébés ; (iii) Montrer que la consultation thérapeutique parents/bébé est un marqueur pertinent de l'évolution permanente de la psychanalyse qui maintient vivante son dynamisme en relevant le défi clinique d'envisager des territoires cliniques jusque-là inédits. Les auteurs mettent en perspective les différents modèles de cadre et pointent les thématiques de recherches cliniques prévalentes. Pour les praticiens de cette consultation périnatale l'engagement simultané dans la recherche et l'enseignement s'impose comme une condition de sa fécondité épistémologique. Pour les praticiens de la consultation parents-bébé, l'engagement simultané dans la recherche clinique et l'enseignement sont les deux conditions de sa fécondité épistémologique. La consultation thérapeutique parents/bébé est un marqueur pertinent du dynamisme d'une psychanalyse vivante grâce à sa confrontation à des défis cliniques inédits. (i) To trace the genesis of therapeutic parent/baby consultations and to point out the epistemological crossroads; (ii) To present the main results of a research project carried out at the Necker Hospital in a parent/baby consultation; (iii) To show that the therapeutic parent/baby consultation is a relevant marker of the permanent evolution of psychoanalysis, which remains dynamic by taking up the clinical challenge of envisaging hitherto unseen clinical territories. The authors put into perspective the different framework models and point out the prevalent clinical research themes. For the practitioners of this perinatal consultation, the simultaneous engagement in research and teaching is essential as two conditions of its epistemological fecundity. For practitioners of parent/baby consultations, the simultaneous engagement in clinical research and teaching are the two conditions of its epistemological fecundity. The therapeutic parent/baby consultation is a relevant marker of the dynamism of a living psychoanalysis thanks to its confrontation with new clinical challenges. [ABSTRACT FROM AUTHOR]

Étudier le processus de parentification à partir du matériel issu d'une psychothérapie chez une patiente suivie en Centre Médico-Psychologique (CMP). Le matériel clinique fait l'objet d'une analyse thématique, une analyse de la dynamique du transfert et du contre-transfert étayée par une réflexion théorique. L'histoire infantile de la patiente est marquée par un renversement générationnel, des imagos parentales envahissantes, des dynamiques identificatoires narcissiques, des relations familiales incestuelles, un couple parental et conjugal dysfonctionnel, une dynamique fraternelle où la parentification de l'aîné (notre patiente) est au premier plan, ainsi qu'une possible transmission intergénérationnelle ou transgénérationnelle de la parentification. Son choix professionnel s'oriente vers un métier de soin. La psychothérapie psychanalytique a permis un meilleur insight, des changements au niveau des imagos parentales et des changements dans la relation aux autres (conjoint, enfants, fratrie, collègues). L'analyse clinique de différents thèmes, l'exploration tridimensionnelle du processus de parentification (intrapsychique, intersubjectif et transubjectif), ainsi que celle de la dynamique transféro-contre-transférentielle nous ont permis de montrer des changements au niveau du fonctionnement psychique de la patiente, de mettre en évidence la nature de l'empreinte de la parentification, ainsi que son élaboration dans la thérapie. La psychothérapie psychanalytique a été utilisée comme méthode d'investigation (des processus conscients et inconscients et d'évaluation du processus de parentification) et également comme méthode de traitement psychothérapeutique. Cette recherche expose la reconstruction de ce qui s'est passé au décours d'une psychothérapie psychanalytique, en ayant comme fil conducteur la problématique de la parentification et de son élaboration, mettant en évidence les éléments cliniques dégagés grâce à l'analyse de la dynamique transféro-contre-transférentielle. The purpose of this article is to highlight the imprint of the parentification process in a patient in the context of a four-year psychoanalytic psychotherapy, through the analysis of the parentification process in its intrapsychic, intersubjective, and transsubjective dimensions. After the end of the therapy, the psychotherapist returns to the material, which involved a patient who presented a depressive disorder and a parentification process during their childhood. We analyzed different themes related to parentification: infantile history, parental imagos , identifying dynamics, parental couple and conjugality, siblings, family functioning, choice of professional career and the relationship to work, and finally, a possible intergenerational or transgenerational transmission of parentification. We observed changes to the patient's subjective suffering: better insight, changes in parental imagos, and also changes in the relationship with others (partner and children) as a consequence of an elaborative process around her parentification. In this case, parentification appears as a response to the traumatic infantile parental perception, as a defensive organization, as a survival solution organized around the symbiotic relationship between the child and the sick parent and, later, in relationships of great dependence with her spouse or her children. Throughout the psychotherapy process we observed: a childhood story marked by a generational reversal, an invasive parental imago , narcissistic identificatory dynamics, a parental couple characterized by dysfunctional conjugality, a special place in her siblings, a familial functioning marked by confusion between roles and generations, a professional choice in the field of care, a potential intergenerational or transgenerational transmission of parentification, and finally a dysfunctional parenthood over several generations. The narcissistic dimension of parentification observed in this patient seems to be linked to the omnipotent position vis-à-vis her "failed" parents, which activates a megalomaniacal narcissism and a heroic masochism. For the psychotherapist, the method of treatment and the method of research overlap. The work of writing this case of psychoanalytical psychotherapy allows for new reflections in its aftermath, other elaborations on the material of the sessions, and a tridimensional exploration of the process of parentification: intrapsychic, intersubjective, and transubjective. We underscore the contribution of the clinical elements revealed by the analysis of the transfer/counter-transference dynamics in the process of deparentification. [ABSTRACT FROM AUTHOR]

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

Dans le contexte du développement clinique de l'oncologie radiothérapie, les spécificités des traitements curatifs et les suivis nécessaires pour l'évaluation de la tolérance à court et à long terme imposent une réflexion méthodologique rigoureuse et actualisée compte tenu de la faisabilité limitée de certaines études pour la démonstration de l'efficacité de ces traitements. En effet, la diversité des traitements proposés en termes de délivrance, de type de rayonnement et de multiples technologies complexifient l'évaluation médicale. Bien que l'essai randomisé contrôlé soit le gold standard pour démonter le lien causal de l'effet du traitement, un état des lieux des limites rencontrées actuellement est réalisé et des propositions de nouvelles approches méthodologiques sont proposées comme possibilités alternatives ou complémentaires : les cocritères de jugement ou critères composites pragmatiques sont à utiliser avec les analyses statistiques adéquates, l'utilisation de méthodes bayésiennes, la réutilisation des données observationnelles pour l'identification de bras contrôle externe et le développement des registres de données de vraie vie est à privilégier afin de pouvoir répondre à cet enjeu colossal. In the context of the clinical development of radiation oncology, the specificities of curative treatments and the necessary follow-ups for the acute and late tolerance evaluation require rigourous and up-dated methodological approaches given the limited feasibility of some studies to demonstrate their effectiveness. Indeed, the diversity of treatments in terms of delivery, type of radiation and multiple technologies render difficult the medical assessment. Although the randomized controlled trial is the gold standard for demonstrating the causal link of the treatment effect size, a state of the art of current limits is presented and proposals for new methodological approaches are discussed as alternative or complementary possibilities. Co-primary endpoints or pragmatic composite endpoints are to be used with adequate statistical analyses, the use of Bayesian methods, the re-use of observational data for the external control arms identification and the development of Real World Data registers is to be preferred to respond to this colossal challenge. [ABSTRACT FROM AUTHOR]

La recherche clinique est une des activités de l'exercice médical, notamment en cancérologie (radiothérapie, oncologie, hématologie, etc.). Elle a été développée dans le secteur public puis dans le secteur libéral, dans le respect des cadres réglementaires, aboutissant à un doublement des inclusions au cours de la dernière décennie. Mettre en place et développer la recherche clinique dans le secteur libéral sont des axes majeurs en termes d'intérêts : améliorer l'offre de soins, accès à l'innovation, conservation de la file active, stimulation intellectuelle, favoriser les recrutements, activité de publications scientifiques, valorisation financière, image de marque, etc. Un état des lieux sur le territoire national via le Syndicat national des radiothérapeutes oncologues (SNRO) et le Club des oncologues libéraux (Colib) est rapporté dans cet article, ainsi que des exemples de structuration et d'organisation. Clinical research is one of the activities of medical practice, particularly in oncology including radiotherapy. It was developed in the public sector and then in the liberal sector, in compliance with regulatory institutions, resulting in a doubling of inclusions over the last decade. Setting up and developing clinical research in the liberal sector are major axes in terms of interests: improving the proposition of care, access to innovation, to keep patients, intellectual stimulation, encouraging recruitment, activity of scientific publications, financial valorisation, quality of visibility... An inventory on French national territory via the national union of iadiotherapists oncologists (SNRO) and the club of liberal oncologists (Colib) is reported in this article, as well as examples of structuring and organization. [ABSTRACT FROM AUTHOR]

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

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The article helps resolve the intricate authorship issue based on global organizations' regulations. It draws a fine line between authorship and contributorship from the research ethics perspective. [ABSTRACT FROM AUTHOR]

This article originates in the broad field of the relationship of psychoanalysis with the university. From the recognition that this relationship is marked by impasses, but also by potentialities, we narrow the focus of our research to the possibilities of clinical research in psychoanalysis. After working with texts by Freud and Lacan, we surveyed some methodologies used for the clinical record in psychoanalysis. Thus we come to our focus on research, the clinical fact. We decided to delimit it by its theoretical potential and formation in psychoanalysis. The relative scarcity of publications in this regard draws attention. Finally we highlight how to operate the clinic with theory. We underline how the concepts of psychoanalytic act, theoretical act and fiction, as operators from the real derived from the clinic, as privileged supports to forge the concepts. From the clinic, we can write around the real, build a case and propose a clinical fact. We consider that it is these theoretical tools that allow us to operate in the abstract field, working hypotheses to touch what is somewhat inaccessible in the clinic and thus we can reap the effects of psychoanalysis, thereby enabling research in the field. [ABSTRACT FROM AUTHOR]

En France, la recherche clinique sur les personnes humaines est encadrée sur le plan réglementaire par la loi Jardé dont les décrets d'application ont été publiés en novembre 2016. L'autorisation d'un comité de protection des personnes est obligatoire pour les recherches interventionnelles et non interventionnelles. Les études sur données provenant des dossiers patients dans le cadre du soin, souvent utilisées pour les travaux de thèse ou de publication, ne sont pas considérées comme des recherches sur les personnes humaines. Ces données médicales sont des données à caractère personnel. La commission nationale de l'informatique et des libertés a également un rôle réglementaire important au cours des recherches cliniques afin de garantir le respect de la réglementation sur les données personnelles. Nous détaillons dans cet article les différents types de recherches, les différentes instances réglementaires et la conduite à tenir en pratique pour effectuer un travail de recherche. In France, clinical research involving human beings is regulated by the Jardé's law since November 2016. The law distinguishes interventional and non-interventional studies. Both need to be authorized by a Persons Protection Committee. Studies performed on medical data collected during standard clinical care are not considered as studies involving human beings. Medical data are personal data. French Data Protection Authority National has an important role, guarantying the respect of regulation on personal data. We summarize in this article the different types of studies and the role of regulatory authorities. [ABSTRACT FROM AUTHOR]

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

La question de la formation aux pratiques psychothérapeutiques des praticiens psychologues et psychiatres apparaît globalement éludée par les facultés. Dans le cadre de la rentrée universitaire, le Professeur Cyril Tarquinio a lancé un appel aux enseignants-chercheurs afin de proposer des solutions pratiques pour développer l'enseignement des psychothérapies. L'article proposé est un entretien réalisé avec le Professeur Cyril Tarquinio en Septembre 2019 au Centre Pierre Janet, service autonome appartenant à l'Université de Lorraine (faculté de psychologie - site de Metz). Dans la plupart des pays d'Europe, soit une différence est faite entre la formation des psychologues cliniciens et celle des psychothérapeutes, soit il est exigé de compléter sa formation académique de Master de psychologie par une formation complémentaire de plusieurs années (300 à 400 heures). Aujourd'hui en France, avec le titre de psychologue clinicien, les étudiants en psychologie deviennent de fait des psychothérapeutes, tout comme les anciens internes de psychiatrie. En réalité, alors que le temps dévoué à l'enseignement des psychothérapies est très restreint à l'université, des générations de praticiens n'ont entendu parler que d'une seule approche (psychanalytique ou cognitivo-comportementale en général). L'hypnose, l'Intégration du Cycle de la Vie, l' Eye Movement Desensitization and Reprocessing , les thérapies psychodynamiques, les approches psychocorporelles, etc., méritent qu'on s'y intéresse. Existe une littérature des plus convaincantes qui atteste de leur pertinence pour ne pas dire de leur efficacité/efficience. Mais ces modèles doivent être envisagés comme des hypothèses en dialogue permanent avec le terrain qui, sans cesse, transforme notre compréhension des idées et conduites de nos patients, ainsi que notre capacité à les prendre en charge. Si ces modèles sont in fine si nombreux, c'est sans doute parce qu'aucun d'entre eux n'est totalement satisfaisant en soi, et/ou qu'il y a une part de vérité en chacun d'eux. Le plus étonnant est qu'ils sont parfois décrits comme opposés les uns aux autres. Au-delà de résistances identiques depuis près d'un demi-siècle, il conviendrait aujourd'hui d'impulser une évolution de la profession de psychothérapeute en développant la formation aux pratiques psychothérapeutiques. Unique en France, service autonome de l'Université de Lorraine fonctionnant sur fonds propres, le Centre Pierre Janet apparaît comme un laboratoire précurseur d'un nouveau modèle de structure universitaire associant de manière cohérente la pratique clinique, l'enseignement aux psychothérapies et la recherche clinique. Alors que la création d'un doctorat spécifique d'exercice apparaît une solution intéressante, devront également être abordées en détail les questions fondamentales de la supervision et de la formation continue. The question of psychotherapists' training in psychotherapeutic practices appears to be generally avoided in French universities. As part of the start of the academic year, Professor Cyril Tarquinio has reached out to teacher-researchers to propose practical solutions to develop the teaching of psychotherapies. The proposed article is an interview conducted with Professor Cyril Tarquinio in September 2019 at the Pierre Janet Center, an independent service belonging to the University of Lorraine (Faculty of Psychology - Metz site). In most European countries, either there is a difference between the training of clinical psychologists and that of psychotherapists, or clinical psychologists are required to complete postgraduate academic training that may last several years (300 to 400 hours of internship) in order to use the title of "psychotherapist." Today in France, students who graduate from clinical psychology programs become de facto psychotherapists, just like junior psychiatrists. In fact, while the time devoted to the teaching of psychotherapies is very limited, generations of practitioners have heard of only one approach (psychoanalytic or cognitive-behavioral in general). Hypnosis, Life Cycle Integration, Eye Movement Desensitization and Reprocessing, psychodynamic therapies, psycho-corporal approaches, etc., deserve attention. There is a growing body of literature that testifies to their relevance, not to mention their effectiveness/efficiency. But these models must be hypotheses in constant dialogue with the field, which constantly transforms our understanding of the ideas and behaviors of our patients, as well as our capacity to take care of them. If these models and theories are ultimately so numerous, it is without doubt because none of them is completely satisfactory in itself or because there is truth in each one of them. The most amazing thing is that they are sometimes light years away from each other, at least in appearance. After a resistance that has lasted for nearly half a century, it would be appropriate today to stimulate an evolution of the profession of psychotherapist by developing training in psychotherapeutic practices. Unique in France, an autonomous service of the University of Lorraine operating on its own funds, the Pierre Janet Center appears as a laboratory precursor of a new model of university structure associating clinical practice, the teaching of psychotherapies, and clinical research in a coherent way. While the creation of a specific PhD appears an interesting solution, the fundamental issues of supervision and continuing education will also need to be addressed in detail. [ABSTRACT FROM AUTHOR]

Résumé: L'intégrité scientifique est un ensemble de règles qui gouvernent la pratique de la recherche et qui ont pour but de faire adopter par chaque chercheur une conduite intègre et honnête. Les manquements à l'intégrité scientifique ont des retentissements et un impact sociétal plus ou moins grands : certains sont pénalement condamnés, d'autres ne font que pénaliser la communauté scientifique. Voilà plus de 10 ans que le sujet de l'intégrité scientifique à grande échelle émerge au travers d'articles spécialisés, d'affaires retentissantes ou de changements institutionnels. À l'heure de la mise en place du plan S en France comme en Europe – peu connu et qui va pourtant dynamiter le monde de l'édition scientifique traditionnel – nous proposons une revue pédagogique de la littérature sur l'intégrité scientifique et plus particulièrement dans le contexte français. [ABSTRACT FROM AUTHOR]

Ce commentaire s’intéresse à la notion de vulnérabilité appliquée aux femmes enceintes en recherche clinique. L’utilisation de cette notion, liée à un problème sémantique, soulève un enjeu éthique et participe à l’exclusion quasi systématique de cette frange de la population du processus de recherche.

This commentary explores the notion of vulnerability applied to pregnant women in clinical research. The use of this notion, related to a semantic problem, raises an ethical issue and participates in the quasi-systematic exclusion of this sub-population from the research process. [ABSTRACT FROM AUTHOR]

Pediatric cancers and acute leukaemias are rare diseases, associated with specific oncogenic mechanisms justifying dedicated research. Immunotherapy has led to spectacular advances in the field of pediatric acute lymphoblastic leukemia, but major efforts still need to improve the outcome of patients with pediatric acute myeloid leukemia (AML). The consolidation of clinical, biological and translational research, led by an ambitious policy conducted by the National Institute for Cancer (INCa), SFCE and patient associations, offers significant progress levers for pediatric oncology in France. The CONECT-AML project on pediatric AML is one example of this policy. Several European (ITCC) and international (ACCELERATE) projects aim to promote access to new drugs and to strengthen international collaborations. [ABSTRACT FROM AUTHOR]

Résumé Le recours à un interprète lors d'une consultation avec un patient allophone, est une pratique de plus en plus fréquente chez les cliniciens. Cependant, l'impact d'une tierce personne sur la relation de soin, notamment sur la construction de l'alliance thérapeutique, est une question peu évoquée dans la recherche sur la psychothérapie. Or, la présence d'un interprète modifie inévitablement le processus thérapeutique en le complexifiant. Elle implique certains aménagements du cadre physique et matériel, et impacte aussi bien les modalités techniques que les modalités de l'entretien, tout comme le contenu des échanges. Des concepts généraux relatifs à l'approche interculturelle seront d'abord présentés. Puis, la question de l'établissement d'une alliance thérapeutique triadique dans une perspective interactionniste et systémique sera abordée à partir de travaux sur des thérapies de couple et de famille ou des consultations précoces parent-nourrisson. L'application de ces modèles à une meilleure compréhension de l'alliance triadique entre thérapeute-interprète-patient, de ses composantes et dimensions spécifiques, sera finalement discutée. Les implications en termes de directions de recherche visant à optimiser la conduite d'une psychothérapie et, plus largement, d'une consultation avec un interprète seront présentées. Abstract The relevance of the use of an interpreter when receiving an allophone patient seems to be more and more accepted among clinicians. However, the influence of this third person on the therapeutic process, and particularly on the establishment of the therapeutic alliance, has received scarce attention so far. The presence of an interpreter inevitably modifies the therapeutic process and makes it more complex. It requires some adjustments of the physical and material setting. It also influences practical arrangements and the very nature of interactions, as well as their content. General concepts about the intercultural approach will first be presented. Subsequently, the issue of the establishment of a triadic therapeutic alliance during a couple and family therapy or mother infant consultations will be discussed from an interactionnist and systemic perspective. The application of these models to a better understanding of patient-therapist-interpreter alliance and its specific components and dimensions will be discussed. Finally, research directions and some clinical considerations to optimize the conduct of a consultation or a psychotherapy with an interpreter will be stressed. [ABSTRACT FROM AUTHOR]

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

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

On January 16, 1992, after a year of work on the part of all concerned, the representatives of 21 associations and scientific societies met at the Inserm (medical research centre) to sign the statutes of the French Federation of Psychiatry (FFP) The objective of the newly formed Federation is for research in all areas of psychiatry and mental health to be anchored in the idea of an open and full exchange of psychiatric practices, at a professional level and on the national and international stage. Major actions are immediately initiated. The cataloguing of these actions and their relationship to identified needs and objectives reflect the coherence of the whole. The contrast apparent between the first 15 years of operation of the FFP and those that follow is considerable. In order to understand this, the Editorial Board of this issue of Psychiatric Perspectives met to consider the question. The role of individual or institutional conflict was not thought to be the main factor. Antagonisms have always existed in psychiatry. They have not succeeded in halting the initial process. We then turned our attention to the publications and documents available to us to see if they could help us to determine what could have changed with regard to relations with those major institutions that have brought their dynamism, guidance and support to the Federation, namely the Inserm, the Andem-Anaes-Has (national French health assessment organization) and the DGS (French Department of Health). Historically the French Federation of Psychiatry has largely concerned itself with the development of EBM (Evidence-Based Medicine) and the particular questions posed by the specificity of psychiatry in the scientific field. The crisis that occurred during the first collective Inserm surveys and the intense work of the interface committee that allowed for at least partial resolution provide an important insight into the consequences that can result from the difference in the construction of knowledge that exists between the general biomedical approach and the individualised approach of psychiatry and related disciplines. The problem stems from the creation of guidelines for clinical practice, while consensus conferences, which have always included family involvement, have never posed any problems, quite the reverse. The research methodology and resulting guidelines for practice must take into account the contribution of the clinical aspect in psychiatry and mental health, including the individualised multifactorial dimension that underlies dysfunctions and their symptomatic and behavioural manifestations. Clinicians have learned to work with dynamic complexity and to adjust their practice to the individuality of each case. The formalisation of this activity represents a potential base of considerable knowledge. Together with other levels of approach, including physiological and biological ones in different conditions such as stress, it can lead to open pragmatic research from which everyone will benefit. [ABSTRACT FROM AUTHOR]

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

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

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

Résumé Les quantités de données générées par les différents outils numériques disponibles sont de plus en plus importantes. En médecine, ces informations peuvent désormais être identifiées et utilisées dans des modèles de prédiction. Il est aussi possible d’évaluer des méthodes et des médicaments au cours d’un essai quasiment en temps réel et surtout durant le quotidien du patient, en “vie réelle”. Summary The quantities of data generated by the different digital tools currently available are ever greater. In medicine, this information can now be identified and used in predictive modelling. It is also possible to assess methods and medicines during a trial more or less in real time and especially in the patient's daily life, in ‘real life’. [ABSTRACT FROM AUTHOR]

Résumé Le traitement des cancers du rectum repose sur une prise en charge pluridisciplinaire et le plus souvent sur une approche multimodale comprenant la gastro-entérologie, l’oncologie médicale, l’oncologie–radiothérapie et la chirurgie. Les différents objectifs qui doivent être discriminés dépendent des caractéristiques de la tumeur. Le défi de la prise en charge des petites tumeurs repose sur la conservation d’un sphincter fonctionnel sans risque de récidive locale. Le traitement standard des maladies localement évoluées vise, par ordre de priorité, à guérir le malade en minimisant les séquelles tardives de la prise en charge. Chacune de ces situations cliniques se trouve désormais démembrée grâce aux progrès de la chirurgie et d’une approche personnalisée au patient à la caractéristique clinique de la maladie. Elles sont désormais l’objet d’études thérapeutiques spécifiques. The treatment of rectal carcinoma is based on multidisciplinary strategy and multimodal approaches including gastrointestinal tract specialists, medical oncologists, radiation oncologists and surgery. The different objectives should be declined according to the characteristics of the tumours. The aim of the therapist would be to select the best strategy offering to the patient to be cured with as less as possible late adverse toxicity. The challenge of the treatment of small tumours is to maintain a functional anal sphincter while minimizing the risk of local recurrence. The standard treatment of locally advanced disease is aiming firstly to cure the patient and secondly to prevent late complications. Each of these clinical presentations of the disease has to be considered as a whole taking into account the new surgical techniques and a personalized approach adapted to the tumour. Nowadays they should be studied with dedicated clinical trials. [ABSTRACT FROM AUTHOR]

Purpose: To describe and compare the type and quality of evidence published in physical therapy (PT) journals during two time periods (2000-2002 vs. 2010-2012) and to explore scientific editors' opinions on changes in the types and quality of articles. Methods: A quantitative, longitudinal, retrospective journal review was used to categorize and assess the methodological rigour of items published in four PT journals using the Hedges Project. A quantitative, descriptive, cross-sectional survey explored the opinions of scientific editors. Percentages and frequencies of article types (as defined by the Hedges Project criteria), items passing rigour, and editor responses were calculated. Statistical significance of differences in article type and rigour between the two time periods was determined using Fisher's Exact Test. Results: There was a significant increase in original studies and review articles from 2000-2002 to 2010-2012 (p<0.001, p=0.002, respectively). The overall pass rate for rigour was 33.3% in 2000-2002 and 42.5% in 2010-2012, showing a significant increase (p=0.019). The majority of editors reported an increase in systematic reviews, qualitative designs, and randomized controlled trials and believed that quality had improved by 2010-2012. Conclusion: From 2000-2002 to 2010-2012, the quality of articles published in PT journals improved and the proportion of original studies and review articles increased. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: La fiabilité diagnostique ou fidélité interjuge, définie comme la concordance entre les diagnostics attribués à un même patient par des psychiatres différents, est retrouvée comme très faible dans les premières études qui lui sont consacrées à partir des années 1950. Pour résoudre ces imprécisions sources de biais dans les études scientifiques, quelques psychiatres de l’American Psychiatric Association décident de changer les principes de la nosographie afin d’optimiser la fiabilité des diagnostics psychiatriques. Si de nos jours une étude scientifique qui n’utiliserait pas ce standard officiel n’aurait que très peu de chance d’être référencée dans la littérature internationale, l’assise scientifique de l’augmentation de la fidélité interjuge grâce aux DSM-III et suivants fait pourtant défaut : très peu d’études ont comparé un diagnostic posé en référence aux DSM avec un diagnostic établi grâce à un entretien clinique non standardisé. Méthodes: Cette pauvreté éditoriale nous paraît traduire la confession d’un échec que nous nous proposons de dépasser grâce à un retour du théorique en différenciant précisément les concepts de fidélité et de validité diagnostique, ce dernier considérant l’existence même du diagnostic en intégrant ses origines étiopathogéniques, sa ű vérité Ƈ clinique et finalement son intérêt pour la prise en charge thérapeutique. Résultats: Les velléités d’ű athéorisme Ƈ ne sont plus d’actualité dans le DSM-V : la validité des diagnostics devrait augmenter par la définition précise de déterminants psychopathologiques et sociologiques associés à la caractérisation de marqueurs biologiques et/ou neuroradiologiques qui construiront une théorie étiopathogénique de chaque phénomène psychique. Discussion: Une telle classification resterait par définition réductrice : un code diagnostique ne sera jamais un sujet en ce sens qu’il ne suffit pas à transmettre notre clinique subjective. Conclusion: Comme lors de notre démarche clinique, la prise en compte de nos subjectivités individuelles et sociétales vers la définition d’une nouvelle nosographie nous semble fondamental à l’avenir de la psychiatrie. [ABSTRACT FROM AUTHOR]

Abstract: Many clinical studies have showed the key role of radiotherapy in anticancer treatment strategy. Radiations are delivered alone or in combination with systemic therapies. In recent years, the main goal of all clinical developments has focused on improving clinical benefit, with an increased tumour control and a higher normal tissue protection. This research was designed to reduce local recurrences, to increase recurrence-free or overall survival and to decrease acute and late effects. Technological and biological evolutions (or revolutions) accompanied clinicians to improve clinical benefit, namely with strong progress in radiology and better understanding of radiobiology, particularly at the molecular level. Differences in tumour and normal tissues radiosensitivity are nowadays integrated in daily clinical practice of radiation oncologists. The current report details the last 5-year developments of clinical and translational research in radiation oncology, especially the role of French teams in the development of personalized treatment. [Copyright &y& Elsevier]

Abstract: Objectives: The aim of this study is to evaluate the effects of the psychodynamic approach in the context of psychoanalytical psychotherapy in clinical interviews conducted by the clinical psychologist. Methodology: It involves analyzing the narrative productions of the interaction patient–psychologist to determine mental processes in a single-case design protocol. This approach integrates the three dimensions qualitative, quantitative and statistical of research. We will test the clinical study with a intensive case or a deeply analyzed single case. Ethics: Our approach answers to the inquiry of evaluation in Public Health, according to the psychoanalytical epistemology into methodology, principle and practice of objectification, intersubjectivity and singularity. By combining research and clinical interviews we would like to respond to be the closest of the patient''s experience and his work of mental development. Results: This work should help to argue the interest of proposals for supportive or psychodynamic psychotherapy in psychiatry as well as medical departments. Being at the heart of the clinic, we focus on the changing processes at work in psychological development work without ever reaching a standardized clinic which would replace the theoretical-clinical orientation of the practitioners. [Copyright &y& Elsevier]

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Clinical research in geriatric oncology is under active development, since aging is heterogeneous and requires specific programs addressing both old and new therapeutic strategies in elderly cancer patients. The group of geriatric oncology, GERICO, launched in 2002 by the French National Federation of Cancer Centres (FNCLCC), has acquired and demonstrated this specific experience. Convinced of the need to integrate the dimensions of functional status and quality of life - key issues in the elderly - it has built several trials on primary endpoints derived from geriatric assessment, different from the traditional tumour response and survival. Today it plans to integrate again classical criteria with geriatric ones. It militates in favour of inclusion of a lower selection of populations and takes into consideration life expectancy which remains so difficult to estimate. [ABSTRACT FROM AUTHOR]

Abstract: Anorexia nervosa, a pathology appearing at adolescence with a clear prevalence in women, remains the object of numerous questions in psychopathology today. Although its frequent association with borderline functioning and its link to the strong presence of object loss anxiety tends to put the Oedipal conflict into the background, it is nonetheless clear that genital sexuality, and more particularly feminine sexuality seems to be implicated in the appearance of these symptoms at adolescence. In the framework of this article, we propose to consider the Feminine in young anorexic girls from the angle of the psychic treatment of the Oedipal conflict and its narcissistic repercussions. By establishing a setting point in the framework of research concerning two types of borderline functioning associated quite often with anorexic symptoms, we will attempt to show how the problem of limits, marked by a faulty differentiation between self and object, inside and outside, interior and exterior, affects the treatment of the difference between the sexes and the Oedipal conflict in its various modalities, with defenses which are more of the inhibited or the labile type. The aim is to bring out, using clinical, projective material (Rorschach and TAT), the problem configurations and the common defensive adjustments in both cases, but also the singular ones, susceptible to shed light on the meaning of the symptoms and thus to improve the methods of treatment which can be proposed. [Copyright &y& Elsevier]

Abstract: Our research consisted in evaluating the interference of the image family body in families concerned by dermatitis helped by a new projective tool: the family drawing of the dream house. We compared 28 drawings from children stuck down by eczema to 28 drawings from general population. Our results show a significative diminution of individuals’ spaces and a research of intimity, which reveals a family representation of a common body. This body prevails to the detriment of individuals building their seilf-sufficiency. The identity landmarks, less clear, would explain the identity troubles found in those cases and eczema would be the symptom. [Copyright &y& Elsevier]

La promotion de la recherche clinique et de l’innovation est une orientation majeure en politique de santé. Afin d’optimiser la prise en charge thérapeutique des patients, le ministère de la Santé a mis en place des programmes hospitaliers de recherche clinique et de soutien aux techniques innovantes coûteuses, pour promouvoir une recherche clinique de qualité et assurer une diffusion efficiente des innovations. [Copyright &y& Elsevier]

Clinical research in geriatric oncology is still in its very early stages. However, the heterogeneous nature of the aging process requires specific programs addressing both old and new therapies for elderly cancer patients. The “Programme d’action concertée d’oncogériatrie” (GERICO group), launched in 2002 by the French National Federation of Cancer Centres (FNCLCC), has acquired and demonstrated this specific experience. Other initiatives include those of cooperative groups such as the European Organization for Research and Treatment of Cancer (EORTC) or the ARCAGY-GINECO group. New assessment criteria, focused on independence and quality of life, two key issues for the elderly, must be associated with the traditional axes of response and survival, whilst translational research is a key direction for future studies. [ABSTRACT FROM AUTHOR]

This document deals with the main aspects of the development of clinical research in cancerology. We describe the organisation of this activity in the Nimes University Hospital and the Faculty of Medicine at Montpellier-Nimes University. [ABSTRACT FROM AUTHOR]

Significant advances in radiation therapy have recently been observed. Important technological advances allow for greater precision in defining target volumes and organs at risk, which will certainly impact the risk/benefit ratio for cancer care, particularly in the new setting of therapeutic associations using new drugs. Despite the major role of radiation therapy in the multidisciplinary management of several cancers, pharmaceutical industry support for radiation therapy trials that do not involve drugs remains nil. Thus, grant applications for radiotherapy studies are mainly oriented towards institutional clinical research. At the same time, research in radiation therapy has changed considerably. In France, since the beginning of the year 2000, the Cancer Institute (INCa) has considered radiation oncology modernisation as one of the health priorities. In their programs, substantial grants have been allocated to the evaluation of innovative techniques, including financial issues and their potential generalisation throughout the country. Funding for clinical research programs has also been allocated to significant projects that will impact future clinical practice. In this article, we aim to describe the various plans for restructuring radiation therapy in France, and make an inventory of the innovative projects in clinical and technology research that involve public and private institutions. [ABSTRACT FROM AUTHOR]

The French Intergroup of Thoracic Oncology (IFCT) aims to develop clinical research in all fields of thoracic oncology, and has recently implemented innovative phase III trials. The purpose of this article is to briefly describe active clinical trials as well as completed studies. [ABSTRACT FROM AUTHOR]

From the strategic use of biology in clinical practice to new diagnostic tools, from the new targeted therapies associated with chemotherapy with controlled side effects, to increasingly accurate radiotherapy associated with increasingly optimised surgery, research in digestive oncology has clearly become multidisciplinary. The challenge now is to develop all these improvements at the same time and with a critical eye, and try to extend the recognized progress made in colorectal metastatic cancer to other digestive localisations whose prognoses are much less positive. In this respect, prevention, optimisation of treatment using predictive factors, management of elderly patients with digestive cancer, and economic optimisation of treatment are some of the challenges we must take up in the next few years if we are to obtain the main objective: truly personalised medicine. [ABSTRACT FROM AUTHOR]

Abstract: The paper is based on clinical research on people living together, whether married or not, and expecting their first baby. The approach is to investigate the manner in which the couple of young parents are in need of their own parents establishing them as both parents and grand-parents, to assert their own parental status both working to achieve a psychological balance and a place in everyday reality. The analysis of the discursive data collected during the semi-directing talks reveals this process with work for these men and women. We present here some significant extracts of the whole of the results. [Copyright &y& Elsevier]

Abstract: The objective of a phase I trials in paediatrics is to determine the recommended dose of a new treatment in children while evaluating its toxicity. These trials are proposed when no effective curative treatment is available. The probability of a benefit in terms of disease control is certainly very low, but greater than zero. On the basis of the work conducted by an Assistance publique-Hôpitaux de Paris Espace éthique group in collaboration with parents, healthcare personnels and a philosopher, phase I therapeutic trials can be considered to be an ethically acceptable proposal provided the criteria and risks of inclusion in such a trial are clearly defined. This article discusses the main elements of this process and is designed to provide guidelines for healthcare personnel and parents. The need for an information provided gently but honestly, the importance of a sufficient time to think about the proposed trial, a two-sided dialogue and partnership between the various actors, and the priority given to the child''s best interest, as should always be the case, constitute the decisive elements to guide the proposed inclusion in a phase I trial. These conditions help to ensure that a decision is reached which appears to be morally founded for all parties, while allowing the child to remain alive up until the end, i.e. a human being capable of relating. This decision allows parents and healthcare personnel to retain a good self-image; if the child dies, it is by keeping their self-esteem that parents can live with their bereavement and healthcare personnel can reinvest in other patients. [Copyright &y& Elsevier]

Abstract: Located at the interface between fundamental research and clinical research the CIT of Bordeaux associates the industrialists, the University Hospital environment in order to develop biomedical research in the field of biomaterials. Thus the CIT of Bordeaux brings a methodological support in the phases of design, development, evaluation which the projects are upstream marking CE, relate to marking CE or are downstream from marking CE. The three axes of CIT biomaterials activities are in vitro preclinic research, preclinic research in vivo and clinical research (clinical studies control). “The study of the modification of the coral by heat treatments and supercritical fluid for its improvement as osseous substitute in odontology and orthopaedic” is a typical project of the CIT biomaterials of Bordeaux. The objective of this project was to evaluate the effectiveness of various innovating techniques of extracellular matrix extraction and their effect on biocompatibility and mechanical performances of the coral, in order to obtain a natural osseous substitute entirely mineral. [Copyright &y& Elsevier]

Since Freud's own time, there has been great deal of debate about the most appropriate research methodology for investigating psychoanalytic psychotherapy [Fonagy, Journal of Child Psychotherapy , 29 (2): 129 – 136, 2003; Rustin, Journal of Child Psychotherapy , 29 (2): 137–145, 2003]. The single case study, which has a long tradition both within child psychotherapy and the wider research field, has been widely criticised as an approach to research, even while its contribution to clinical practice, the development of new ideas and teaching have been acknowledged. After reviewing the history of case study as a research method, this paper argues that there are a broad range of approaches to the study of the single case, each of which may be appropriate depending on the particular research question. Each of these approaches, however, must respond to the three perceived weaknesses of the clinical case study as a research method: the ‘data problem’, the ‘data analysis problem’ and the ‘generalisability problem’. This paper outlines the nature of these criticisms and, using many examples of actual research projects, suggests various ways in which the criticisms can be addressed, in order for the single case study to re-gain its place at the heart of psychoanalytic research. [ABSTRACT FROM AUTHOR]

Quality of life (QoL) assessment in cancer clinical trials has been taken into consideration for over 20 years. It proved particularly relevant for specific breast cancer treatments, since it brings an added value to select the optimal treatment. Guidelines for assessing QoL in cancer clinical trials are available. Research on QoL assessment in clinical practice is promising. This approach is meant to identify physical and psychosocial symptoms and problems. Its aims is also to provide a more adequate response to patients’ overall care needs, which should help their adherence to medical recommendations. Improvement in the technology of QoL assessment, as well as in QoL data analysis and interpretation, should make the use of QoL evaluation easier in the routine delivery of care. [ABSTRACT FROM AUTHOR]