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International audience; Background: Patient suicide (PS) is known to be a frequent and challenging occupational hazard for mental health professionals. No study previously explored the prevalence and impact of PS in a large sample of French psychiatrists.Method: A national web-based survey was performed between September and December 2019 to assess (a) the prevalence of the exposure to PS, (b) the emotional, traumatic and professional impacts of PS, and (c) the perceived support in the aftermath of PS in French psychiatrists. Participants were contacted through email to answer the online 62-item questionnaire, including a measure of traumatic impact through the Impact of Event Scale-Revised. Emotional and professional impacts and perceived support were assessed through dedicated items.Results: A total of 764 psychiatrists fully completed the survey. Of them, 87.3% reported an exposure to PS and 13.7% reported PTSD symptoms afterward. Guilt, sadness and shock were the most frequent emotions. Among the exposed psychiatrists, 15.1% have temporarily considered changing their career path. The most emotionally distressing PS occurred during their ten first years of practice or during residency. A total of 37.1% of respondents felt unsupported and 50.4% reported that no team meeting had been organized in the aftermath. The feeling of responsibility for the death was strongly associated with negative impacts.Conclusion: Our results entail considerations to prevent negative mental health outcomes in psychiatrists after PS. Notably, our results advocate for the implementation of educational programs during psychiatric residency and postvention programs in healthcare settings to effectively help psychiatrists in dealing with PS.

International audience; Ce texte fait partie du livre Soigner la technologie ? Cahier d'enquêtes autoproduit par le collectif Stasis à Montréal entre 2018 et 2021. Stasis cherche à outiller manières de vivre, imaginaires et modes de lutte en questionnant les mondes contemporains (https://groupestasis.com/). Soigner la technologie? est disponible au Québec sur lepressier.com (https://lepressier.com/products/soignerla-technologie) et en France chez C&F éditions (https://cfeditions.com/stasis/)

International audience; The Research Domain Criteria project (RDoc) proposes a new classification system based on information from several fields in order to encourage translational perspectives. Nevertheless, integrating genetic markers into this classification has remained difficult because of the lack of powerful associations between targeted genes and RDoC domains. We hypothesized that genetic diseases with psychiatric manifestations would be good models for RDoC gene investigations and would thereby extend the translational approach to involve targeted gene pathways. To explore this possibility, we reviewed the current knowledge on Prader–Willi syndrome, a genetic disorder caused by the absence of expression of some of the genes of the chromosome 15q11–13 region inherited from the father. Indeed, we found that the associations between genes of the PW locus and the modification identified in the relevant behavioral, physiological, and brain imaging studies followed the structure of the RDoC matrix and its six domains (positive valence, negative valence, social processing, cognitive systems, arousal/regulatory systems, and sensorimotor systems).

Mémoire de stage de Master 1 Neurosciences - Sciences du comportement; Background: Animal-assisted interventions are new therapeutic approaches that are developing in health care systems. What about horse mediation? The study aimed to review the equine-assisted intervention effects on the biopsychosocial dimensions of psyciatric patients. Methods: The original studies were selected through systematic search from 9 databases (Bibliothèque de l’Université de Paris, Brill, CAIRN, CISMeF, Cochrane Library, DOAJ, EBSCOHost, PubMed and Science Direct) with the following keywords: « psychiatry and hippotherapy » and « psychiatry and equine-assisted therapy »..Results: Among the 30 articles selected, 70% concerned the effects of equine-assisted intervention (EAI) on children and adolescents (vs 30% on adults). The majority of the studies focused on neurodevelopmental disorders (53%) and especially on the autistic spectrum (40%). Most studies (77%) included ground and horseback riding activities. They highlight the positive effects of EAI on certain dimensions (79% of results). It should be noted that EAI programs are not standardised and that methodological biases have to be taken into account in the interpretation of the results.Conclusion: EAI is an original therapeutic approach in psychiatry. Our study shows that it is necessary to promote research in this field, particularly in adult populations, with a rigorous methodology, with a high level of proof, to scientifically validate its therapeutic efficacy.; Contexte : Les interventions assistées par l’animal constituent des nouvelles approches thérapeutiques en plein essor dans les dispositifs de soins. Qu’en est-il de la médiation par le cheval ? Cette revue systématique de la littérature a eu pour objectif de faire le point sur les études internationales ayant testé les effets de la médiation équine chez les patients suivis en psychiatrie.Méthodes : Les articles originaux sur le sujet ont été sélectionnées à partir d’une recherche systématique dans 9 bases de données (Bibliothèque de l’Université de Paris, Brill, CAIRN, CISMeF, Cochrane Library, DOAJ, EBSCOHost, PubMed et Science Direct) et les mots clefs « psychiatry and hippotherapy » et « psychiatry and equine-assisted therapy ».Résultats : Parmi les 30 articles sélectionnés, 70% concernaient des études réalisées chez les enfants/adolescents (vs 30% chez les adultes). Ont été en majorité étudiés les effets de la médiation équine sur les troubles neurodéveloppementaux (53%) et notamment ceux du spectre autistique (40%). La plupart des études (77%) ont intégré des activités à pied et montées à cheval. Elles mettent en évidence des effets positifs de la médiation équine sur certaines dimensions biopsychosociales (79% des résultats obtenus). A noter que les programmes ne sont pas standardisés et que des biais méthodologiques sont à considérer dans l’interprétation des résultats. Conclusion : La médiation équine pourrait constituer une approche thérapeutique originale en psychiatrie. Notre étude montre qu’il est cependant encore nécessaire de favoriser les recherches dans ce domaine, notamment dans les populations adultes, avec une méthodologie rigoureuse, à fort niveau de preuve, pour valider scientifiquement son efficacité thérapeutique.

The majority of adolescents with mental health problems do not experience continuity of care when they reach the transition boundary of their child and adolescent mental health service. One of the obstacles for a smooth transition to adult mental health services concerns the lack of training for health-care professionals involved in the transition process. This study aims to seek psychiatric trainees' opinions regarding training on transition and the knowledge and skills required for managing transition. A survey was distributed to trainees residing in European countries. Trainees from 36 countries completed the questionnaire, of which 63% reported that they came into contact with youth and young adults (16-26 years) during their clinical practice. Twenty-seven percent of trainees stated they have good to very good knowledge about the transition process. Theoretical training about transition was reported in only 17% of the countries, and practical training in 28% of the countries. Ninety-four percent of trainees indicated that further training about transition is necessary. The content of subsequent transition-related training can be guided by the findings of the MILESTONE project. ispartof: EUROPEAN CHILD & ADOLESCENT PSYCHIATRY vol:29 issue:1 pages:41-49 ispartof: location:Germany status: published

The aim of this study was to explore the experience of psychiatrists conducting qualitative studies. Seven psychiatrists-researchers were interviewed using a semi-directive interview. Data were analyzed within a phenomenological thematic approach. Three themes emerged from the analysis: 1) how the participants discovered and got access to qualitative methods 2) their experience of qualitative method 3) how and why they felt that psychiatry was a field that could be naturally explored by qualitative methods. This study allowed us to show a lack of use and knowledge of these methods among medical students and physicians. The results show how useful and relevant qualitative research can be in the field of mental health, for the improvement of the quality of the field itself, for the patients but also for the psychiatrists conducting these research in their clinical practice.; L’objectif de cette étude était d’explorer le vécu des psychiatres qui ont réalisé des recherches avec des méthodes qualitatives. Sept entretiens semi-dirigés ont été menés avec des psychiatres dont une interne en psychiatrie. Les données ont fait l’objet d’une analyse thématique phénoménologique. Cette analyse a fait émerger trois thèmes : 1) comment les participants ont rencontré la méthode qualitative, 2) leur expérience de la recherche qualitative en elle-même et (3) comment la psychiatrie leur apparait comme une discipline médicale adéquate à l’exercice de la méthode qualitative. Notre étude a permis de mettre en lumière un manque de connaissances et d’utilisation des méthodes qualitatives dans l’enseignement et dans la recherche médicale. Mais elle a permis également de confirmer l’utilité et l’intérêt des méthodes qualitatives dans le champ de la santé mentale à la fois pour ce qu’elle apporte à la discipline, aux patients et aussi aux chercheurs-psychiatres eux-mêmes dans la pratique de leur métier.

Objectives: to study the level of tobacco information of psychiatric patients, their smoking profile, their motivation for withdrawal and access to aids, comparing them with those of patients in addiction or with chronic illness.Method: cross-sectional observational study of patients in psychiatry, addiction and endocrinology, by self-questionnaire.Results: 249 people participated, 55 in psychiatry, 134 in addiction and 60 in endocrinology. Respectively, 53%, 77% and 22% were active smokers. All participants think that tobacco is dangerous for health. More than 30% of psychiatric patients considered smoking cessation to lead to a worsening of psychiatric disorders. 46% of smokers in psychiatry want to quit smoking and 20% in the coming month. NRTs and e-cigarettes are used by more than 60% of psychiatry or addictology consultants. Six out of ten smokers discussed stopping smoking with a health professional, regardless of the group.Discussion: psychiatric patients are quite well informed about the risks and generalities of smoking. The impact of smoking on psychiatric illnesses was less known, even in psychiatry. More than half of psychiatric smoking consultants are motivated to initiate smoking cessation. They have access to help comparable to other groups.Conclusion: the delay taken by psychiatry in the prevention and management of smoking seems to have been caught up. It is now necessary to go further and integrate the specificity of this population.; Objectifs : étudier le niveau d’information sur le tabac des patients en psychiatrie, leur profil tabagique, leur motivation au sevrage et l’accès aux aides, en les comparant avec ceux de patients en addictologie ou ayant une maladie chronique.Méthode : étude observationnelle multicentrique transversale auprès de patients en psychiatrie, addictologie ou endocrinologie, par auto-questionnaire.Résultats : 249 personnes ont participé, 55 en psychiatrie, 134 en addictologie et 60 en endocrinologie. Respectivement, 53 %, 77 % et 22 % étaient fumeurs actifs. La totalité des participants pensent que le tabac est dangereux pour la santé. Plus de 30 % des patients en psychiatrie considéraient que l’arrêt du tabac entraine une aggravation des troubles psychiatriques. 46 % des fumeurs en psychiatrie ont envie d’arrêter de fumer et 20 % dans le mois à venir. Les TNS et la cigarette électronique sont utilisés par plus de 60 % des consultants en psychiatrie ou en addictologie. Six fumeurs sur dix ont discuté de l’arrêt du tabac avec un professionnel de santé, quel que soit le groupe.Discussion : les patients en psychiatrie sont plutôt bien informés des risques et généralités sur le tabac. L’impact du tabagisme sur les maladies psychiatriques était moins connu, même en psychiatrie. Plus de la moitié des fumeurs consultants en psychiatrie sont motivés pour initier un sevrage tabagique. Ils ont un accès aux aides comparable aux autres groupes.Conclusion : le retard pris par la psychiatrie sur la prévention et la prise en charge du tabagisme semble avoir été rattrapé. Il est désormais nécessaire d’aller plus loin et d’intégrer la spécificité de cette population.

Bariatric surgery is indicated in obese patients with a BMI ≥ 40 kg/m² or ≥ 35 kg/m² with serious comorbidities, in second intention in patients who failed to achieve significant weight loss after a well managed medical, nutritional and psychotherapeutic treatment for 6 to 12 months, and in patients who are aware of the consequences of bariatric surgery and who agree with a long term medical and surgical follow-up. Such a treatment requires a preoperative multidisciplinary assessment and management, which includes a mandatory consultation with a psychiatrist or a psychologist that should be member of the multidisciplinary staff and participate in these staff. -Although one of this consultation’s aim is to screen for the few patients who for which surgery is contraindicated, in most cases, the main aim of this assessment is to screen for and manage psychiatric and psychopathologic disorders that could be temporary contraindication, because these disorders could lead to poorer postoperative outcome when untreated. By explaining to the patient how these disorders could affect postoperative outcome and which benefits he could retrieve from their management, the patient will increase his motivation for change and he will be more likely to seek professional help for these disorders. In all cases, a systematic examination of the patient’s personality and his/her ability to understand the postoperative instructions is essential before surgery because clinicians should check that the patient is able to be adherent to post-operative instructions. In addition to clinical interview, use of self-administered questionnaires before the consultation might help to determine which psychiatric or psychopathologic factors should be more closely screened during the consultation. - Psychiatric disorders and addictions are highly prevalent in this population (e.g., mood and anxiety disorders, binge eating disorder, Attention Deficit Hyperactivity Disorder, addictions, personality disorders, pathological personality traits and dimensions), and when untreated, they can lead to poorer postoperative outcome (postoperative occurrence of psychiatric disorders, poorer quality of life, and sometimes to poorer weight loss or excessive weight rebound when the disorder is present during the postoperative period). A complementary training in addiction medicine is helpful given the higher risk for addictions in this population. - Given that this evaluation is often the first meeting with a psychiatrist, an empathic and motivational approach is helpful to improve the patient’s ability to request for a future psychiatric consultation during the follow-up.- Some conditions are required for a high quality assessment: the objectives and expectations of the consultation should be systematically explained to the patient prior to the consultation by the physician who enquires for the assessment; its needs time; the psychiatrist should systematically be member of the multidisciplinary staff and should take part in regular multisciplinary staff meetings; patients should be seen alone to assess his/her readiness to change. - After the consultation, a contact with the physician who enquires for the assessment should be systematic (e.g., use of a medical letter that sum up the main conclusions of the consultation; participation in regular multisciplinary staff meetings)., La chirurgie de l’obésité est indiquée chez les sujets ayant un IMC ≥ 40 kg/m² ou ≥ 35 kg/m² avec comorbidités somatiques, en deuxième intention après échec d’un traitement médical, nutritionnel, diététique et psychothérapeutique bien conduit pendant 6 à 12 mois, chez des patients bien informés, ayant compris et acceptés la nécessité d’un suivi médical et chirurgical à long terme. Ce traitement nécessite une évaluation et une prise en charge préopératoires pluridisciplinaires, avec notamment une évaluation obligatoire par un psychiatre ou un psychologue qui doit être membre de l’équipe pluridisciplinaire et qui doit participer aux réunions de l’équipe. -Si un des objectifs de cette évaluation est de repérer les patients pour lesquels il existe une contre-indication psychiatrique absolue, dans la plupart des cas, il convient surtout d’identifier et de prendre en charge précocement les troubles psychiatriques et psychopathologiques pouvant constituer des contre-indications temporaires, car ils peuvent être des facteurs de risque de moins bonne évolution postopératoire s’ils ne sont pas pris en charge. En expliquant au patient l’impact potentiellement délétère de certains troubles sur l’évolution postopératoire et en lui expliquant le bénéfice qu’il pourra retirer de leur prise en charge, le patient pourra développer une plus grande motivation pour les soins et il pourra solliciter plus facilement les professionnels de santé. Dans tous les cas, il est important d’effectuer également un examen de la personnalité du patient et de ses capacités de compréhension avant de prendre la décision chirurgicale, car il est nécessaire de s’assurer avant l’intervention que le patient soit capable d’être observant sur le long cours vis-à-vis des consignes de suivi postopératoire. En complément de l’évaluation clinique de ces troubles, la passation d’auto-questionnaires avant la consultation peut être utile pour orienter l’entretien clinique vers les dimensions à explorer plus en détails.-Les troubles psychiatriques et les addictions sont fréquents dans cette population (troubles dépressifs, troubles anxieux, hyperphagie boulimique, Trouble Déficitaire de l’Attention avec Hyperactivité, addictions, troubles de la personnalité, dimensions et traits de personnalité pathologiques), et ils peuvent être associés à une moins bonne évolution postopératoire (survenue de troubles psychiatriques, altération de la qualité de vie mais aussi parfois moindre perte de poids ou reprise excessive de poids à long terme en cas de trouble postopératoire). Une formation complémentaire en addictologie est utile du fait de la vulnérabilité de ces patients aux addictions. -Cette consultation étant souvent l’occasion pour le patient d’une première rencontre avec un psychiatre, une approche empathique et motivationnelle est utile ; de plus, ce type d’approche permet de favoriser le recours ultérieur à cette consultation.-Plusieurs conditions permettent d’effectuer un bilan de qualité : les objectifs et attentes de l’évaluation doivent avoir été explicités au patient avant la consultation par le médecin demandeur (afin que le patient puisse bien comprendre quels bénéfices éventuels il pourrait retirer d’une prise en charge psychiatrique ou addictologique) ; cette consultation nécessite du temps ; le psychiatre doit être membre de l’équipe pluridisciplinaire et être présent au cours des réunions multidisciplinaires pour échanger avec les autres membres de l’équipe ; le patient doit pouvoir être reçu seul en consultation pour évaluer sa motivation intrinsèque à l’opération.-Après la consultation, les contacts sont systématiques avec le médecin demandeur, à la fois via un courrier détaillant les conclusions de l’évaluation et via la participation aux réunions de concertation pluridisciplinaires.

The aetiology of psychiatric disorders remains poorly understood, despite significant progress in neurosciences and psychopharmacology. These approaches might be limited by their lack of causal account linking psychiatric symptoms and neurobiological data. This dissertation presents a new theoretical approach of psychopathology, i.e. computational psychiatry, that aims to develop and test hypotheses about the algorithms that the brain implements to produce observable behavior. To that purpose, we review two major computational models. First, models from reinforcement learning and neuro-economics give a novel account of symptoms as a decision making process gone awry (such as addiction, impulsiveness, compulsions or apathy). Then, we examine how Bayesian modeling of probabilistic inference enlightens psychotic symptoms. Finally, we discuss the limitations and future applications of computational approaches in psychiatry.; L’étiologie des maladies psychiatriques est encore mal connue, malgré d’importants progrès en neurosciences et en psychopharmacologie. La limite que rencontrent ces approches tient probablement à l’absence de modèles explicatifs permettant de lier causalement les symptômes psychiatriques et les données neurobiologiques. Cette thèse aborde une nouvelle approche théorique de la psychopathologie, la psychiatrie computationnelle, dont l’objectif est de proposer et de tester empiriquement des hypothèses quant aux algorithmes implémentés par le cerveau, à l’origine des comportements observés. Pour cela, nous présentons deux grands types de modèles computationnels. Premièrement, les modèles issus de l’apprentissage par renforcement et de la neuro-économie, permettent de redéfinir les symptômes traduisant une altération de la prise de décision (addiction, impulsivité, compulsions, apathie). Deuxièmement, nous examinons en quoi les modèles bayésiens d’inférence probabiliste apportent un éclairage sur les symptômes psychotiques. Enfin, nous discutons dans un troisième temps les limites et perspectives de l’approche computationnelle en psychiatrie.

Objectif : le maintien dans l’emploi des salariés atteints d’un trouble psychiatrique est difficile. L’objectif de notre étude était d’évaluer la collaboration entre médecins du travail et psychiatres afin de savoir si elle doit être améliorée. Méthode : nous avons réalisé une étude transversale descriptive et quantitative par questionnaire diffusé en ligne. Notre population cible était les médecins du travail exerçant dans un service interentreprises d’Ile-de-France. Résultats : 106 médecins du travail ont répondu au questionnaire. 58,5% jugeaient la collaboration avec les psychiatres comme étant plutôt mauvaise. 60,4% contactaient souvent ou très souvent les psychiatres par courrier, 68% les contactaient jamais ou rarement par téléphone. 56,6% estimaient que les psychiatres leur répondaient souvent ou très souvent et 93,4% estimaient que les psychiatres les contactaient spontanément jamais ou rarement. Après sollicitation, les psychiatres répondaient plutôt bien aux attentes des médecins du travail concernant les informations médicales et plutôt mal concernant la prise en charge socioprofessionnelle. Les médecins du travail pensaient que lespsychiatres ne comprenaient pas bien leur métier, qu’ils étaient réticents à leur transmettre des informations médicales et qu’ils avaient des doutes sur leur indépendance professionnelle. Conclusion : notre étude a montré que selon les médecins du travail, la collaboration entre médecins du travail et psychiatres doit être améliorée. Des études ultérieures permettraient de compléter nos résultats.

Contexte : l'utilisation de l'isolement en psychiatrie et pédopsychiatrie soulève des questionnements cliniques, éthiques et déontologiques. La première loi française d'encadrement des pratiques d'isolement et de contention a été promulgée le 26 janvier 2016. Elle précise que l'isolement doit intervenir en "dernier recours". La Haute Autorité de Santé vient de publier des recommandations concernant l'utilisation de la contention et de l'isolement en psychiatrie. Plus que jamais, les professionnels de santé et, en première ligne, le psychiatre, sont appelés à justifier et interroger cette pratique. Méthode : après avoir exploré les différentes théories qui sous tendent l'utilisation de la chambre d'isolement, et plus particulièrement la notion de contenance, nous présentons trois cas clinique illustrant chacun une utilisation particulière de la chambre d'isolement. Les questions soulevées par l'analyse des cas sont confrontées à une revue de la littérature internationale et française. Discussion : après rappel des données épidémiologiques existantes sur l'utilisation de la chambre d'isolement en France, nous nous interessons au vécu des patients. Nous présentons par la suite deux protocoles visant à diminuer les pratiques d'isolement au sein d'établissements de santé aux Etats Unis. Nous tentons par la suite d'exposer les spécificités de l'isolement en pédopsychiatrie.Tout au long de ce travail nous insistons sur l'information donnée au patient isolé et sur l'utilité des entretiens de débriefing post-isolement pour le patient mais aussi pour les équipes. Car au delà de la clinique individuelle du patient, la dimension institutionnelle de l'utilisation de la chambre d'isolement doit être prise en compte pour en garantir un éventuel effet thérapeutique. Conclusion : la diminution des pratiques d'isolement est un objectif prioritaire dans nombre de pays à l'international. En France, les professionnels sont appelés à se questionner sur l'utilisation de la chambre d'isolement à un niveau clinique, thérapeutique et institutionnel pour atteindre ce même objectif.

Cervical cancer is the second most common cancer among women under the age of 45 in France, however screening coverage fort this cancer is still insufficient, specifically in psychiatric population, especially at risk. The aim of this study is specifying the barriers for cervical cancer screening with Pap smear test reported by patients with any psychiatric pathologies. We used a qualitative survey through the analysis of semi-structured interviews conducted with 16 women recruited from psychiatric institution. The women interviewed declared themselves misinformed about how this screening takes place and its players especially the general practionner, quoted only by the half of the sample. Socioeconomical and socio-cultural factors, the difficulty of access to gynaecologists’ practices, the lake of personnel initiative or even the denial of the disease were mentioned but didn’t seemed to be the most important : it was modesty and fear above all, barriers closely associated with the representation of the gynecological exam and cancer. Similar barriers were found in general population. This study had also shown the women’s ambivalence towards screening behavior. Incentive by their general practitioner and organised campaigns were identified as the best way to attend this screening program, rather than a massive information. This study suggests the women seems to be in favor of a better communication and involvement by their general practionner in the perform of their Pap smear test within the context of organised campaigns recommending screening.; Le cancer du col de l’utérus est le deuxième cancer chez la femme jeune avant 45 ans en France, cependant la couverture du dépistage pour ce cancer reste insuffisante notamment en population psychiatrique particulièrement à risque. L’objectif de l’étude est d’identifier les obstacles au dépistage du cancer du col de l’utérus par frottis cervico-utérin déclarés par des patientes atteintes d’un trouble psychiatrique quel qu’il soit. Nous avons réalisé une étude qualitative par entretiens semi-dirigés chez 16 patientes hospitalisées en psychiatrie. Les patientes interrogées se disaient mal informées à propos des modalités de réalisation de ce dépistage et de ses acteurs notamment du médecin généraliste cité par uniquement la moitié de l’échantillon. Des facteurs socio-économiques, sociéto-culturels, la difficulté d’accès aux soins gynécologiques, le manque d’initiative ou encore le déni de la maladie étaient évoqués mais ne semblaient pas être les plus importants : il s’agissait surtout de la pudeur et de la peur, obstacles étroitement liés aux représentations de l’examen gynécologique et du cancer. Des obstacles semblables sont retrouvés en population générale. Cette étude a également souligné l’ambivalence des femmes face aux pratiques de dépistage. L’incitation par le médecin généraliste et le dépistage organisé apparaissaient comme être les meilleures solutions pour améliorer la participation au dépistage plus qu’une information de masse. Cette étude suggère que les femmes seraient plus favorables à une meilleure communication et implication de leur médecin généraliste dans la réalisation de leur frottis cervico-utérin dans le cadre d’un dépistage organisé.

While the well-care of the vulnerable finds growing public awareness and illustrates the significant improvement in ethical concern over the last decades, particularly regarding the children and the elderly, the psychiatric sector seems slower to integrate this new approach into its professional practice. After defining the idea of well-care and related concepts – mistreatment as well as some ethical principles –, this study questions the limits of the concept of well-care. Well-care inherently suffers from blurred contours and also from a certain lack of clarity of the promotion and awareness messages on the subject issued by the health authorities who act in this case as judge and jury by also fulfilling the mission of evaluating and controlling the quality of care services. To better understand the place of ethical questioning and well-care in psychiatry, this study traces the history of the psychiatric sector, presents the principles of institutional therapy and outlines the current state of the French psychiatric sector highlighting the challenges it faces. The close links between politics, law and psychiatry make relevant the analysis of the use of the word well-care in the French “Psychiatry and Mental health” plans, in the laws governing psychiatric care and in the recommendations for good professional practice. By means of a field survey combining two distinct methods, one quantitative and the other qualitative, in three inpatient units of a psychiatric adult sector, this study accounts for the perception of well-care by professionals and their difficulties to seize and integrate the ethical values associated with well-care in everyday practice. Finally, this study offers orientations to help develop concrete measures in order to improve awareness and well-care actions grounded in field reality of professionals working in a psychiatric sector. These measures to promote well-care in psychiatric sectors can inspire and help elaborate medical projects in psychiatric wards or establishments but to have true ethical value they must proceed from brainstorming to include all the participants intervening in the care process: staff both medical and non -medical, patients...; Alors que la bientraitance des personnes vulnérables trouve un écho grandissant auprès de l’opinion publique et illustre les avancées éthiques importantes des dernières décennies, notamment concernant les enfants et les personnes âgées, le secteur psychiatrique semble plus long à intégrer la question de la bientraitance aux pratiques professionnelles. Après avoir défini le concept de bientraitance et les notions qui s’y rattachent – la maltraitance ainsi que certaines notions d’éthique –, cette étude questionne les limites du concept de bientraitance. La bientraitance souffre intrinsèquement de contours flous mais également d’un certain manque de lisibilité des messages de sensibilisation et de promotion sur ce sujet diffusés par des autorités sanitaires qui sont ici juge et partie puisqu’elles assurent également la mission d’évaluation et de contrôle de la qualité des soins. Afin de mieux comprendre la place du questionnement éthique et de la bientraitance en psychiatrie, cette étude retrace l’histoire du secteur psychiatrique, présente les principes de la thérapie institutionnelle puis dessine le visage du secteur actuel en soulignant les défis auxquels il doit faire face. Les liens étroits entre politique, droit et psychiatrie rendent pertinente l’analyse de la façon dont la bientraitance est inscrite dans les plans « Psychiatrie et Santé mentale », les lois encadrant les soins en psychiatrie ainsi que dans les recommandations de bonnes pratiques professionnelles. Au travers d’une enquête de terrain en deux parties, l’une quantitative et l’autre qualitative, au sein de trois unités d’hospitalisation d’un secteur de psychiatrie adulte, cette étude rend compte de la perception de la bientraitance par les professionnels ainsi que leurs difficultés à se saisir, s’approprier et mettre en pratique au quotidien les valeurs éthiques associées la bientraitance. Enfin, cette étude propose des pistes de réflexion pour élaborer des mesures concrètes de sensibilisation et de promotion de la bientraitance adaptées au vécu des professionnels. Ces mesures de développement de la bientraitance en secteur psychiatrique peuvent inspirer des projets de service ou d’établissement mais, pour avoir une réelle valeur éthique, nécessitent d’être le fruit d’une réflexion de tous les acteurs du soin : personnel médical et non-médical, usagers…

Background: Mental health policy and new therapies have enabled rehabilitation of women with schizophrenia during the past 60 years and thus favored an increase of the number of pregnancies in this population, but we don’t have the actual prevalence. In addition to the handicap due to pathology, these patients have a higher socio-professional insecurity, more psychiatric comorbidities and pregnancy complications, than the general population. The limited expertise of professionals on perinatal mental health and the lack of coordination between psychiatric and obstetrical teams make the follow-up of those women uneasy.Objective: Description of diagnostic identification methods and of multidisciplinary care; description of medical, social and psychological characteristics of the sample, for pregnancy and health outcomes for mother and child; discussion of our results with those of the National Perinatal Survey, in general population.Material & Method: It is a retrospective study of all pregnancies of women identified with a diagnosis of schizophrenia over the last 6 years (2010-2015) in 4 type III maternity units (Port Royal, Kremlin Bicêtre, Louis Mourier, Centre intercommunal de Créteil). The data come from records of schizophrenic patients at maternity or psychiatry units. The 4 maternity units had no significant differences in the main characteristics of patients included and thus the description has been made on the entire sample.Results: 68 schizophrenic patients were included; this means 77 pregnancies and 80 births over the period. There is a deficit in the identification of these women. The sample patients had more obstetric and neonatal complications than women in the general population.Conclusion: Our results seem to confirm the data found in the literature regarding pregnancy in schizophrenic patients. However, deficit of identification of these pregnancies certainly underestimate the observed prevalence and does not allow a generalization of our results to all pregnant women with schizophrenia. A networking and multidisciplinary should be routinely performed to reduce tracking difficulties and improve pregnancy outcomes in patients with schizophrenia.; Contexte : Les politiques de santé mentale et les nouvelles thérapeutiques ont permis une réinsertion des femmes présentant une schizophrénie durant ces 60 dernières années et donc favorisé une l’augmentation du nombre des grossesses au sein de cette population sans qu’on en ait vraiment une prévalence précise. En plus du handicap induit par la pathologie, ces patientes présentent une plus grande précarité socio-professionnelle, diverses comorbidités psychiatriques et plus de complications de grossesse, que la population générale. Les connaissances limitées des professionnels sur la santé mentale périnatale et le défaut de coordination entre les équipes psychiatriques et obstétricales rendent difficile le repérage de ces femmes.Objectifs : Description des modalités de repérage diagnostic et de prise en charge pluridisciplinaire ; description des caractéristiques médico-socio-psychologiques de l’échantillon, du suivi de grossesse et des issues de santé pour la mère et l’enfant ; discussion de nos résultats avec ceux notamment l’enquête nationale périnatale, en population générale.Matériel & Méthode : une étude rétrospective de toutes les grossesses de femmes identifiées avec un diagnostic de schizophrénie, sur les 6 dernières années (2010-2015), dans 4 maternités franciliennes de type III (Port-Royal, Kremlin Bicêtre, Louis Mourier, Centre Intercommunal de Créteil). Les données proviennent des dossiers de patientes schizophrènes en maternité ou en psychiatrie. Les 4 maternités n’avaient pas de différences significatives pour les principales caractéristiques des patientes incluses et donc la description a été faite sur l’ensemble de l’échantillonRésultats : 68 patientes schizophrènes ont été incluses, soit 77 grossesses et 80 naissances sur la période. Il existe un déficit dans le repérage de ces grossesses. Les patientes de l’échantillon ont présenté plus de complications obstétricales et néonatales que la population générale des femmes venant d’accoucher.Conclusion : Nos résultats semblent confirmer les données retrouvées dans la littérature concernant les grossesses chez les patientes schizophrènes. Toutefois, le déficit de repérage de ces grossesses entraine certainement une sous-estimation de la prévalence observée et donc ne permet pas une généralisation de nos résultats à l’ensemble des femmes schizophrènes enceintes. Un travail en réseau et pluridisciplinaire devrait être systématiquement réalisé afin de réduire les difficultés de repérage et d’améliorer le déroulement des grossesses chez les patientes présentant une schizophrénie.

Document In Press non encore publié donc pas encore de référence de volume / numéro, pages, etc...; International audience; - Bariatric surgery is indicated in obese patients with a BMI ≥ 40 kg/m² or ≥ 35 kg/m² with serious comorbidities, in second intention in patients who failed to achieve significant weight loss after a well managed medical, nutritional and psychotherapeutic treatment for 6 to 12 months, and in patients who are aware of the consequences of bariatric surgery and who agree with a long term medical and surgical follow-up. Such a treatment requires a preoperative multidisciplinary assessment and management, which includes a mandatory consultation with a psychiatrist or a psychologist that should be member of the multidisciplinary staff and participate in these staff. -Although one of this consultation’s aim is to screen for the few patients who for which surgery is contraindicated, in most cases, the main aim of this assessment is to screen for and manage psychiatric and psychopathologic disorders that could be temporary contraindication, because these disorders could lead to poorer postoperative outcome when untreated. By explaining to the patient how these disorders could affect postoperative outcome and which benefits he could retrieve from their management, the patient will increase his motivation for change and he will be more likely to seek professional help for these disorders. In all cases, a systematic examination of the patient’s personality and his/her ability to understand the postoperative instructions is essential before surgery because clinicians should check that the patient is able to be adherent to post-operative instructions. In addition to clinical interview, use of self-administered questionnaires before the consultation might help to determine which psychiatric or psychopathologic factors should be more closely screened during the consultation. - Psychiatric disorders and addictions are highly prevalent in this population (e.g., mood and anxiety disorders, binge eating disorder, Attention Deficit Hyperactivity Disorder, addictions, personality disorders, pathological personality traits and dimensions), and when untreated, they can lead to poorer postoperative outcome (postoperative occurrence of psychiatric disorders, poorer quality of life, and sometimes to poorer weight loss or excessive weight rebound when the disorder is present during the postoperative period). A complementary training in addiction medicine is helpful given the higher risk for addictions in this population. - Given that this evaluation is often the first meeting with a psychiatrist, an empathic and motivational approach is helpful to improve the patient’s ability to request for a future psychiatric consultation during the follow-up.- Some conditions are required for a high quality assessment: the objectives and expectations of the consultation should be systematically explained to the patient prior to the consultation by the physician who enquires for the assessment; its needs time; the psychiatrist should systematically be member of the multidisciplinary staff and should take part in regular multisciplinary staff meetings; patients should be seen alone to assess his/her readiness to change. - After the consultation, a contact with the physician who enquires for the assessment should be systematic (e.g., use of a medical letter that sum up the main conclusions of the consultation; participation in regular multisciplinary staff meetings).; -La chirurgie de l’obésité est indiquée chez les sujets ayant un IMC ≥ 40 kg/m² ou ≥ 35 kg/m² avec comorbidités somatiques, en deuxième intention après échec d’un traitement médical, nutritionnel, diététique et psychothérapeutique bien conduit pendant 6 à 12 mois, chez des patients bien informés, ayant compris et acceptés la nécessité d’un suivi médical et chirurgical à long terme. Ce traitement nécessite une évaluation et une prise en charge préopératoires pluridisciplinaires, avec notamment une évaluation obligatoire par un psychiatre ou un psychologue qui doit être membre de l’équipe pluridisciplinaire et qui doit participer aux réunions de l’équipe. -Si un des objectifs de cette évaluation est de repérer les patients pour lesquels il existe une contre-indication psychiatrique absolue, dans la plupart des cas, il convient surtout d’identifier et de prendre en charge précocement les troubles psychiatriques et psychopathologiques pouvant constituer des contre-indications temporaires, car ils peuvent être des facteurs de risque de moins bonne évolution postopératoire s’ils ne sont pas pris en charge. En expliquant au patient l’impact potentiellement délétère de certains troubles sur l’évolution postopératoire et en lui expliquant le bénéfice qu’il pourra retirer de leur prise en charge, le patient pourra développer une plus grande motivation pour les soins et il pourra solliciter plus facilement les professionnels de santé. Dans tous les cas, il est important d’effectuer également un examen de la personnalité du patient et de ses capacités de compréhension avant de prendre la décision chirurgicale, car il est nécessaire de s’assurer avant l’intervention que le patient soit capable d’être observant sur le long cours vis-à-vis des consignes de suivi postopératoire. En complément de l’évaluation clinique de ces troubles, la passation d’auto-questionnaires avant la consultation peut être utile pour orienter l’entretien clinique vers les dimensions à explorer plus en détails.-Les troubles psychiatriques et les addictions sont fréquents dans cette population (troubles dépressifs, troubles anxieux, hyperphagie boulimique, Trouble Déficitaire de l’Attention avec Hyperactivité, addictions, troubles de la personnalité, dimensions et traits de personnalité pathologiques), et ils peuvent être associés à une moins bonne évolution postopératoire (survenue de troubles psychiatriques, altération de la qualité de vie mais aussi parfois moindre perte de poids ou reprise excessive de poids à long terme en cas de trouble postopératoire). Une formation complémentaire en addictologie est utile du fait de la vulnérabilité de ces patients aux addictions. -Cette consultation étant souvent l’occasion pour le patient d’une première rencontre avec un psychiatre, une approche empathique et motivationnelle est utile ; de plus, ce type d’approche permet de favoriser le recours ultérieur à cette consultation.-Plusieurs conditions permettent d’effectuer un bilan de qualité : les objectifs et attentes de l’évaluation doivent avoir été explicités au patient avant la consultation par le médecin demandeur (afin que le patient puisse bien comprendre quels bénéfices éventuels il pourrait retirer d’une prise en charge psychiatrique ou addictologique) ; cette consultation nécessite du temps ; le psychiatre doit être membre de l’équipe pluridisciplinaire et être présent au cours des réunions multidisciplinaires pour échanger avec les autres membres de l’équipe ; le patient doit pouvoir être reçu seul en consultation pour évaluer sa motivation intrinsèque à l’opération.-Après la consultation, les contacts sont systématiques avec le médecin demandeur, à la fois via un courrier détaillant les conclusions de l’évaluation et via la participation aux réunions de concertation pluridisciplinaires.

Obsessive-compulsive disorder (OCD) is a frequent and severe disease, leading to impairment for the patient and his family. Recent research in psychiatry and neuroscience led to better comprehension of disease’s mechanisms and helped to improve the treatment. However, a large quantity of patients show a resistance to the existent therapeutics, leading the practitioners to try find new treatments. The mindfulness psychotherapy is a new type of therapy developed successfully in some psychiatric diseases, such generalized anxiety disorder (GAD) and depression. Its action relies on the specific correction of cognitive caracteristics shared by OCD, GAD and depression. This thesis proposes a review of the existing literature about OCD and mindfulness psychotherapy, hypothesis on the mechanism of action of this therapy in OCD, and finally presents the results of a clinical studies aiming to prove the interest of the use of mindfulness in OCD.; Le Trouble obsessionnel-compulsif (TOC) est une pathologie fréquente, potentiellement sévère, entraînant un handicap important pour le patient et son entourage. Les avancées récentes de la psychiatrie et des neurosciences ont permis une meilleure compréhension de la maladie et la mise au point de traitements plus efficaces. Pour autant, une part importante de patients présente des résistances, motivant la recherche de thérapeutiques nouvelles. Les psychothérapies mindfulness sont un type de thérapie récemment développé avec succès dans certaines pathologies psychiatriques, comme le trouble anxieux généralisé (TAG) et la dépression. Leur action est sous tendue par la correction de certaines caractéristiques neuropsychologiques pouvant se retrouver aussi bien dans le TOC que dans le TAG et la dépression. Nous proposons ici une revue des connaissances sur le TOC et les thérapies mindfulness, des hypothèses sur leur mécanisme d’action dans cette pathologie, et les résultats d’un protocole expérimental que nous avons mis en place au cours de notre troisième cycle.

Psychiatry is a medical discipline characterized by psychically weakening diseases, and alegislation about the hospitalization of patients.Health Law of March 4th 2002 introduces the possibility for all patients, without distinction forpsychiatry, to designate a Trusted Person who could accompany him on his course of care and/orspeak for his will when he is not able to express himself. The information provided on this law bothto patients and health professionals is often incomplete, largely assimilated to situations of end oflife, so out of context in psychiatry. Yet this Trusted Person is an evaluation indicator of mentalhealth facilities by the High Authority of Health.Moreover psychiatric patients, whose consent to health care is questioned during forcedhospitalizations, are a particularly sensitive population regarding the limits of the respect of theirrights at the hospital. A survey of patients in a psychiatric ward, during regular or forcedhospitalization, makes the inventory on the subject of the Trusted Person. The study of foreignmodels of psychiatric Trusted Person equivalents raises the same debate about the accessibility toinformation and the introduction of a third party for the patient in psychiatry. It would be relevantto provide the means to better involve health professionals in order to apply the law as it is set outbefore considering a new model of trusted person in psychiatry.; La psychiatrie est une discipline médicale caractérisée par des pathologiesparticulièrement fragilisantes sur le plan psychique, et l’existence d’une législation concernantl’hospitalisation de ses patients. La loi de santé du 4 mars 2002 introduit la possibilité pour toutpatient, sans distinction faite pour la psychiatrie, de désigner une personne de confiance quipourrait l’accompagner dans son parcours de soins et/ou être le porte-parole de ses volontés s’iln’est pas en mesure de s’exprimer. L’information délivrée sur cette loi aux patients comme auxprofessionnels de santé est souvent incomplète, assimilée surtout à des situations de fin de vie,donc hors sujet en psychiatrie. Pourtant cette personne de confiance fait l’objet d’un indicateurd’évaluation des établissements de santé mentale par la Haute Autorité de Santé.D’autre part les patients en psychiatrie dont le consentement aux soins est remis en question lorsdes hospitalisations sous contrainte, représentent une population particulièrement sensible en cequi concerne les limites du respect de leurs droits à l’hôpital. Une enquête réalisée auprès despatients d’un service de psychiatrie, en soins libres ou en soins sous contrainte, sur le sujet de lapersonne de confiance en fait l’état des lieux. L’étude des modèles étrangers d’équivalents depersonne de confiance en psychiatrie soulève le même débat de l’accessibilité à l’information et del’introduction d’un tiers pour le patient en psychiatrie. Il conviendrait de se donner les moyens demieux impliquer les professionnels de santé pour appliquer la loi telle qu’elle est énoncée avantd’envisager un nouveau modèle de personne de confiance en psychiatrie.

International audience; Although Alzheimer s disease is classified as a neurodegenerative dementia, in Alzheimer s dementia there is increasing evidence of an association with vascular risk factors and vascular pathology. These observations are supported by epidemiological and pathological studies. Vascular factors may play a significant role in the pathogenesis of Alzheimer s dementia. Further research is needed to explore this relationship. Modification of vascular risk factors could make a significant impact towards prevention and treatment of Alzheimer s disease, which is a distressing and prevalent condition in the community. This article considers the relationship of these vascular risk factors and potential mechanisms associated with the aetiopathogenesis of Alzheimer s dementia.

The contraceptive advice involves regular intervention of a general practitioner or a gynecologist. It is bordered by the recommendations of the HAS (2013) and must be adapted, personalized and chosen by the patient.The aim of our study was to observe the demographic and medical characteristics involved in the choice of a contraception in patients with psychiatric disease and reveal the specifics of contraceptive advice in these patients.Of the 100 patients interviewed, 43 have a contraception (against 90 in the general population).Sociodemographic factors as: eligibility to a Disability Allowance or a measure of legal protection, appear to be related to lower rates of contraception and show impaired autonomy of these patients. Medical factors as suffering from schizophrenia and personality disorders are associated with lower rates of contraception compared to other psychiatric disorders.The most chosen contraceptions are the intrauterine device and the contraceptive implant. They are more used than in the general population and seem suitable for these patients suffering from difficulties with adherence. They are here routinely prescribed by gynecologists, whitch rises questions on the practices of general practitioners.Lack of contraception is often due to a lack of information.Therefore, general practitioners, and gynecologists, must know the medical, demographic and behavioral characteristics of their patients provide an appropriate contraceptive advice whithin dedicated consultations.; Le conseil contraceptif implique régulièrement l’intervention d’un médecin généraliste ou d’un gynécologue. Il est encadré par des recommandations de la HAS (2013) et doit être adapté, personnalisé et choisi par la patiente.L’objectif de l’étude est d’observer les caractéristiques sociodémographiques et médicales influençant la contraception chez des patientes atteintes d’une pathologie psychiatrique et de révéler les spécificités du conseil contraceptif chez elles.Sur les 100 patientes interrogées, 43 prennent une contraception (contre 90 en population générale).Les facteurs sociodémographiques comme bénéficier d’une Allocation Adulte Handicapé ou d’une mesure de protection juridiques, semblent liés à un plus faible taux de contraception et témoignent d’une altération de l’autonomie. Les facteurs médicaux comme souffrir de schizophrénie et de trouble de la personnalité sont associés à un taux de contraception plus bas par rapport aux autres pathologies psychiatriques.Les contraceptions les plus souvent choisies sont le dispositif intra utérin et l’implant contraceptif. Ils sont plus utilisés qu’en population générale et semblent adaptés à ces patientes souffrant de difficultés d’observance. Ils sont, ici, systématiquement prescrits par les gynécologues. Cela questionne sur les pratiques des médecins généralistes. L’absence de contraception est souvent liée à un manque d’information.Le médecin généraliste, comme le gynécologue, doit connaître les spécificités médicales, sociodémographiques et comportementales de ses patientes.

International audience; Nanomedicine is defined as the area using nanotechnology's concepts for the benefit of human beings' health and well being. In this article, we aimed to provide an overview of areas where nanotechnology is applied and how they could be extended to care for psychiatric illnesses. The main applications of nanotechnology in psychiatry are (i) pharmacology. There are two main difficulties in neuropharmacology: drugs have to pass the blood-brain barrier and then to be internalized by targeted cells. Nanoparticles could increase drugs bioavailability and pharmacokinetics, especially improving safety and efficacy of psychotropic drugs. Liposomes, nanosomes, nanoparticle polymers, nanobubbles are some examples of this targeted drug delivery. Nanotechnologies could also add new pharmacological properties, like nanoshells and dendrimers (ii) living analysis. Nanotechnology provides technical assistance to in vivo imaging or metabolome analysis (iii) central nervous system modeling. Research teams have succeeded to modelize inorganic synapses and mimick synaptic behavior, a step essential for further creation of artificial neural systems. Some nanoparticle assemblies present the same small worlds and free-scale networks architecture as cortical neural networks. Nanotechnologies and quantum physics could be used to create models of artificial intelligence and mental illnesses. We are not about to see a concrete application of nanomedicine in daily psychiatric practice. Even if nanotechnologies are promising, their safety is still inconsistent and this must be kept in mind. However, it seems essential that psychiatrists do not forsake this area of research the perspectives of which could be decisive in the field of mental illness.

International audience; The purpose of this study was to identify clinician characteristics associated with higher prescription rates of long-acting injectable (LAI) antipsychotics, as well as the sources that influence medical decision-making regarding the treatment of schizophrenia. We surveyed 202 psychiatrists during six regional French conferences (Bordeaux, Lyon, Marseille, Nice, Paris, and Strasbourg). Data on the characteristics of practice, prescription rates of antipsychotic, and information sources about their clinical decisions were collected. Most psychiatrists used second-generation antipsychotics (SGAs), and preferentially an oral formulation, in the treatment of schizophrenia. LAI SGAs were prescribed to 30.4% of schizophrenic patients. The duration and type of practice did not influence the class or formulation of antipsychotics used. The clinicians following the higher percentage of schizophrenic patients were associated with a higher use of LAI antipsychotics and a lower use of oral SGAs. Personal experience, government regulatory approval, and guidelines for the treatment of schizophrenia were the three main contributing factors guiding clinicians' decision-making regarding the treatment of schizophrenia. The more clinicians follow schizophrenic patients, the more they use LAI antipsychotics. The development of specialized programs with top specialists should lead to better use of LAI antipsychotics in the treatment of schizophrenia.

International audience; The treatment modalities of bipolar disorder and adherence to international guidelines recommendations in France were investigated. We conducted an observational survey among 210 French psychiatrists concerning their prescribing practice in bipolar disorder, and whether they use guidelines or not. Simple mania is mainly treated with valproate, whereas second-generation antipsychotics are preferred for delusional mania. Lithium is mostly used as second-line treatment by "young psychiatrists." Personal experience appears in the foreground (41% of psychiatrists) in the choice of therapy. Young psychiatrists refer more to guidelines (32% of responders) as compared with other psychiatrists. The main reason for the lack of use of guidelines is because they refer mostly to an Anglo-Saxon medical practice, which is considered different from the French practice. Guidelines for treatment of bipolar disorder are not frequently used. French psychiatrists' age and practice type are the most important variables correlated to the level of use of guidelines.

International audience; Functional stereotaxy was introduced in the late 1940s to reduce the morbidity of lobotomy in psychiatric disease by using more focal lesions. The advent of neuroleptics led to a drastic decline in psychosurgery for several decades. Functional stereotactic neurosurgery has recently been revitalized, starting with treatment of Parkinson's disease, in which deep brain stimulation (DBS) facilitates reversible focal neuromodulation of altered basal ganglia circuits. DBS is now being extended to treatment of neuropsychiatric conditions such as Gilles de la Tourette syndrome, obsessive-compulsive disorder, depression and addiction. In this review, we discuss the concept that dysfunction of motor, limbic and associative cortico-basal ganglia-thalamocortical loops underlies these various disorders, which might now be amenable to DBS treatment.

International audience; The interactions between developing neurology and psychiatry in Paris are of interest, in a city which was the main center for studies on the nervous system and its disorders during the nineteenth century. Contrary to a common view, and in spite of an established tradition for mental diseases, emerging neurology had a much stronger influence on psychiatry ('alienism') than the reverse. This was largely due to the school built up by Jean-Martin Charcot, which was organized around the study and management of hysteria. Although Charcot himself always claimed his disinterest in mental medicine, he stimulated the development of an original scientific approach to nervous system conditions, along with a structured academic teaching, while alienism paradoxically remained stuck in organicism, after Antoine Bayle's report in 1822 of 'arachnitis' as the substratum of general paresis of the insane. Contrary to alienism, the young neurological school was able of self-criticism, and progressively underscored mental factors in hysteria. This led to the paradox that neurologists were active in a disease with a recognized lack of organic lesion, while alienists were postulating brain lesions in all mental disorders. The neurological activity thus indirectly and involuntarily led to the first developments of psychodynamic concepts in mental diseases. The academic evolution led to the launch of a faculty chair of mental and brain diseases in 1875, which was taken over for nearly half a century by direct pupils of Charcot: Benjamin Ball, Alix Joffroy, and Gilbert Ballet held the position until 1916, supporting the development of modern psychiatry in general hospitals, while alienism progressively disappeared at the turn of the century.

International audience; The Bordeaux Neuroscience Institute brings together all the disciplines that constitute the clinical and experimental neurosciences. Outside of the Paris region, the Institute represents the largest community of researchers working on the nervous system. The aim of this brief historical piece is to describe how neuroscientists in Bordeaux are the heirs to a long neuropsychiatric tradition established by pioneers of national and international renown. This tradition has been maintained, without interruption, through many generations. The careers and scientific work of these great neurologists and psychiatrists are briefly evoked, and particularly those of A. Pitres, E. Régis and E. Azam in the 19th century; and, in the 20th century, J. Abadie, H. Verger and R. Cruchet. The determining influence of P Delmas-Marsalet (1898-1977), Professor of Neuropsychiatry, on the development of modern neurosciences in Bordeaux is recalled through his work, his teachings, and his numerous students.

International audience

Moynihan describes the defeated efforts of a group of psychiatrists to free the annual Congress of the Royal Australia and New Zealand College of Psychiatrists from drug company sponsorship.1 These psychiatrists can take heart from the fact that the British Royal College of Psychiatrists conducted its 2008 annual meeting without reliance on any industrial sponsorship. The success of the conference shows that a …

International audience; Nowadays, catatonia is no more considered as a subtype of schizophrenia. Catatonia seems more frequently associated to mood disorders as well as general medical conditions. It is sometimes difficult to associate formally a medical etiology to this syndrome. But we found, in the literature, three groups of associated general medical conditions: neurological disorders, drug induced and toxic induced conditions, metabolic conditions. We present a prospective study of 12 clinical cases of catatonia due to general medical conditions we realized in the Consultation-Liaison Psychiatry Department of the University Hospital of LILLE (France) during a period of 5 months. We find coherent data with the literature. However, our results suggest that if medical conditions precipitate the catatonia syndrome, they are rarely its only etiology. We think that if somatic factors are co-morbid with psychiatric conditions they do not necessarily predominate as the target of treatment. The treatment of the catatonia must be a priority and remain symptomatic, to allow in parallel the specific treatment for the somatic disorder or the psychiatric disorder.

Olivier Cottencin4, Marc Lambert, Viviane Queyrel, David Launay, Sandrine Morell-Dubois, Eric Hachulla, Pierre Yves Hatron, Michel Goudemand, Silla M. Consoli Department of Consultation/Liaison Psychiatry, University of Medicine, Paris 5, AP-HP, European Georges Pompidou Hospital, Paris, France CNRS, UMR 8160, Lille, France Department of Internal Medicine, University of Lille 2 and University Hospital of Lille, Lille, France Department of Psychiatry, University of Lille 2 and University Hospital of Lille, Lille, France

International audience; One of the problems of consultation-liaison psychiatry is the absence of request of the patient. Indeed, the patients do not recognize their disorder and prefer to go to the emergency unit in a general hospital. Thus, we meet in the emergency unit or in medical unit (liaison psychiatry activity). This is the reason why this first meeting has to be prepared. Consultation-liaison Psychiatry proposes to provide medical staff with the competences developed by psychiatry, and the denomination: Consultation and Liaison Psychiatry, indicates the bipolarity of its practice according to whether the intervention is addressed to the patient (consultation) or to the staff (liaison). However collaboration is sometimes difficult and the psychiatrist often meets with resistance. This is the reason why psychiatrists must work on their integration in the general hospital. Indeed, the psychiatrist works in an institution which is unfamiliar and he/she must adapt and create new practices if it is going to work. It is now clearly established that consultation-liaison psychiatry is not limited to consultations with patients, but is based on collaboration with medical staff. There are various ways of studying human problems: psychoanalysis, cognitive therapy, behavioural therapy. It is also possible to focus interest on the communication between individuals. The systemic therapies are interested in the interactions more than with any other aspect of reality, and this always from a pragmatic point of view. This concept is based on a series of designs. First of all, an intervention by problem solving aims at a change: the question is to know how a problem is maintained, hic et nunc. Secondly, humans are a sum of training by tests and errors. Finally, what we call reality is only our perception of reality: the human conflicts emerge when two persons assign a different direction to a reality which is perceived jointly. The human relationship can be defined as interaction circles, which we propose to use in our practice of consultation-liaison psychiatry. The question is no longer to know why the subject has a problem but to know how to resolve it. The call for a consultation of psychiatry is often the result of an interaction between patient and staff. We propose an assessment of the consultation-liaison-psychiatry's demand so as to offer a concrete response to medical teams and patients. 1. First of all, the claimant should be known. This first question is to be asked before even meeting the patient. In the majority of cases, it is the medical staff that suffers from the situation (and wants a change). To work only on the patient, discredits the psychiatric intervention. 2. The definition of the problem is a concrete question, which we want based on the facts and not on the comments. That which requires the consultation (the patient, his/her family or the medical team) awaits concrete answers from the psychiatrist. It is important that the objectives of the intervention are defined before meeting the patient. These preliminary exchanges facilitate the consultation-liaison intervention. 3. By knowing the solutions tried before the request for psychiatric help, the psychiatrist will be able to know the measures already tried (whether they were effective or not). 4. By proposing minimal changes, it defines small but obtainable objectives, which will be as much as to increase therapeutic alliance and the tolerance of patients sometimes difficult to understand. 5. Finally, the consultation-liaison psychiatrist must know the language of his/her interlocutors. Interdisciplinary alliance is a fundamental condition for the success of the intervention: like the patients, the medical staff must feel understood to be able to cooperate. To develop this alliance and to inhibit resistance, it is important to speak the language of the claimant. The demand will progressively become interventions, more adapted, especially when the psychiatrist is recognized and appreciated by the team, like a good consultant, credible and concrete. Thus, mentally distressed patients can benefit from psychiatric care (although they do not request it). However, two phases appear essential. First, we have to define the demand and the claimant (environment, medical staff and patient) and second, we have to support the integration of the psychiatrist in the functioning of the medical unit. Our systemic vision of the consultation-liaison psychiatry proposes a pragmatic collaboration, centred on the problem. This approach allows the patient to prepare to meet the psychiatrist, and does not a priori discredit the intervention. Presented by the staff, who know the problem in concrete terms and are ready to answer it in a concrete way, this mode of intervention is only the first step of subsequent psychiatric care.

International audience; Depression is a frequent symptom in psychiatry, either isolated (major depression) or entangled with other psychiatric symptoms (psychotic depression, depression of bipolar disorders). Many antidepressant drugs are available with different pharmacological profiles from different classes: tricyclic antidepressants, monoamine oxydase inhibitors, selective serotonin reuptake inhibitors (SSRI). However, there are some limitations with these drugs because there is a long delay before relief for symptoms, some patients with major depression are resistant to treatment, there is a risk to induce manic symptoms in patients with bipolar disorders and these drugs have no effect on the psychotic symptoms frequently associated to major depression. The leading hypothesis for the search of more efficient new antidepressants has been the amine deficit hypothesis: noradrenaline and/or serotonin deficit and more recently dopamine deficit. Moreover, a dopamine deficit has been also hypothesized as the central mechanism explaining the negative symptoms of schizophrenia. These symptoms are the consequence of a deficit of normal behaviours and include affective flattening, alogia, apathy, avolition and social withdrawal. There is thus a great overlap between symptoms of depression and negative symptoms of schizophrenia. Atypical antipsychotics, in contrast with conventional neuroleptics, have been shown to decrease negative symptoms, most probably through the release of dopamine in prefrontal cortex, thus improving psychomotor activity, motivation, pleasure, appetite, etc. The dopamine deficit in cortical prefrontal areas was thus an unifying hypothesis to explain both some symptoms of depression and negative symptoms of schizophrenia. Studies in animal confirm this view and show that the association of an atypical antipsychotic drug and an SSRI (olanzapine plus fluoxetine) increases synergistically the release of dopamine in prefrontal areas. Moreover, most of the atypical antipsychotics have a large action spectrum, beyond the only dopamine receptors: their effects on the serotonin receptors--particularly the 5-HT2A and 5-HT2C receptors--suggest that their association to SSRI could be a promising treatment for depression. Indeed, SSRI act mainly by increasing the serotonin level in the synapse, thus leading to a non specific activation of all pre- and post-synaptic serotonin receptors. Among them, 5-HT2A/2C receptors have been involved in some of the unwanted effects of SSRI: agitation, anxiety, insomnia, sexual disorders, etc. The inhibition of these receptors could be thus beneficial for patients treated with SSRI. Amisulpride is an unique atypical antipsychotic that selectively blocks dopamine receptors presynaptically in the frontal cortex, possibly enhancing dopaminergic transmission. The antidepressant effect of amisulpride was shown in dysthymia in many clinical studies versus placebo, tricyclic antidepressants, SSRI or others. However, a shorter delay for symptom relief was not demonstrated for amisulpride as compared to comparative antidepressants. Other atypical antipsychotics (clozapine, olanzapine), which act on a large variety of receptors, have shown antidepressant effects--mainly in association with SSRI--in different psychiatric diseases: treatment-resistant major depression, major depression with psychotic symptoms and depression of bipolar disorders, with no increase of manic symptoms in this latter case. Moreover, the delay for symptom relief was greatly shortened. More comparative double-blind studies are required to confirm and to precise the antidepressant effects of atypical antipsychotics. Nevertheless, these studies suggest that atypical anti-psychotics could be of great value in depressive conditions reputed for their resistance to treatment with usual antidepressants. Particularly, new strategies emerge that combine atypical antipsychotics and antidepressants for greater efficacy and more rapid relief of depression symptoms.

International audience; This paper explores service users' experiences of a 'person-centred' mental health service. We describe the development of a model of social psychiatry that places the emphasis on the experiences of the person within social and political contexts. This establishes the foundations of a 'person-centred' approach, the values of which are described briefly. The results of interviews with 20 people are presented, in which their experiences of the service are explored in detail. These interviews reveal the struggle that lies at the heart of the professional-service user dialectic, which relates to issues of institutional power, roles and responsibility, and which places professional staff in conflict with the very notion of 'person-centredness'. No matter how 'person-centred' a mental health service may strive to be, there remain serious obstacles to the full realization of this approach. Despite this critique, there were many things that were valued by those who used the service. More detailed qualitative studies are required to explicate the complex relationships and paradoxes that emerged.

Government policies are beginning to change the ethos of mental health care in Britain. The new commitment to tackling the links between poverty, unemployment, and mental illness has led to policies that focus on disadvantage and social exclusion.1 These emphasise the importance of contexts, values, and partnerships and are made explicit in the national service framework for mental health.2 The service framework raises an agenda that is potentially in conflict with biomedical psychiatry. In a nutshell, this government (and the society it represents) is asking for a very different kind of psychiatry and a new deal between health professionals and service users. These demands, as Muir Gray has recently observed, apply not only to psychiatry but also to medicine as a whole, as society's faith in science and technology, an important feature of the 20th century, has diminished.3 According to Muir Gray, “Postmodern health will not only have to retain, and improve, the achievements of the modern era, but also respond to the priorities of postmodern society, namely: concern about values as well as evidence; preoccupation with risk rather than benefits; the rise of the well informed patient.”3 Medicine is being cajoled into accepting this reality, but psychiatry faces the additional problem that its own modernist achievements are themselves contested. Consider this: although patients complain about waiting lists, professional attitudes, and poor communication, few would question the enterprise of medicine itself. By contrast, psychiatry has always been thus challenged. Indeed, the concept of mental illness has been described as a myth.4 It is hard to imagine the emergence of “antipaediatrics” or “critical anaesthetics” movements, yet antipsychiatry and critical psychiatry are well established and influential.5 One of the largest groups of British mental health service users is called Survivors Speak Out. Psychiatry has reacted defensively …

Background: “Vascular depression” has recently been proposed. It is characterized by magnetic resonance imaging (MRI) T2-weighted subcortical lesions, a late onset of first episode of depression, and reduced heritability; a cerebrovascular etiology is suggested. The validity of “vascular depression” might be strengthened if an association was found between the subcortical lesions used to define it and particular depressive symptoms. Methods: A blinded cross-sectional examination of DSM-III-R depressive symptoms (American Psychiatric Association, 1987) and MRI T2-weighted subcortical lesions in 44 patients with late-life depression. Results: Many associations were found; however, because of multiple comparisons, their significance is viewed with caution. The most robust finding was that psychomotor retardation was independently related to total white-matter score. The odds of showing psychomotor retardation was increased 1.9 times for every point increase in severity of white-matter change. Conclusion: In late-life depression the clinical expression of the depression is influenced by the pattern of MRI T2-weighted subcorticallesions. This gives some validity to the concept of an MRI-defined “vascular” subtype of late-life depression and strengthens the argument for including neuroimaging in the classification of late-life depression.