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Resume Objectifs LIVIA est une intervention psychologique par Internet en dix modules sur une duree de trois mois pour personnes presentant une souffrance psychique apres la perte de leur partenaire par deces, separation ou divorce. Traduite d’un programme allemand dont l’efficacite a ete demontree par une etude randomisee controlee, la version francaise de LIVIA a ete proposee en Suisse romande, en version non guidee, dans le cadre d’une etude d’implementation pilote visant a en verifier l’accueil. Methode Sur 148 personnes inscrites suite a une presentation du programme dans des journaux ou a la radio, 24 ont participe integralement a l’essai clinique et ont fourni les mesures de pretest et posttest sur leurs symptomes de deuil, d’anxiete et de depression, leurs modes d’adaptation a la perte, leur support social, leur sentiment de solitude ainsi que leur bien-etre. Elles ont pu egalement exprimer leur degre de satisfaction vis-a-vis du programme et formuler des commentaires a son sujet. Resultats La mediane de participation au programme est de six modules : dix personnes ont realise neuf a dix modules, cinq ont accompli moins de la moitie des seances prevues. Des benefices significatifs ont ete observes sur les symptomes de deuil et sur les strategies d’evitement. Aucune autre amelioration n’a ete relevee sur la symptomatologie depressive, anxieuse, sur le bien-etre, la satisfaction existentielle ou encore la solitude. La satisfaction vis-a-vis de l'intervention est globalement bonne. Neanmoins, quelques points negatifs ont pu etre releves : les textes explicatifs ont ete juges complexes et les exercices de confrontation plutot penibles, surtout en l’absence de soutien d’une personne ressource. Ceux-ci ont pu favoriser la diminution de l’engagement dans le programme. Conclusion LIVIA, dans sa version francaise non guidee, permet de reduire la symptomatologie du deuil et les strategies d’evitement suite a un deces ou une separation. Le programme merite cependant des ameliorations pour satisfaire un public plus large et ameliorer son adhesion a la demarche.

BACKGROUND Internet-based interventions (IBIs) are as efficient as face-to-face psychotherapy for a variety of mental health disorders, including complicated grief. Most evidence stems from guided IBIs. However, recent research indicates that the benefit of guidance is lower in more interactive IBIs. As such, providing guidance only to people requiring it (guidance on demand) appears a cost-effective solution. This is particularly important to develop given the recent rise in grief symptoms in the context of the COVID-19 pandemic. This paper presents the protocol of a randomized controlled trial comparing the efficacy and adherence rate of 2 IBIs for grief-related symptoms after the loss a close one following death or romantic separation, using a guidance on demand framework. LIVIA 2.0 was developed based on theoretical and empirical findings on grief processes and IBIs, and it will be compared to LIVIA 1 that has already demonstrated its efficacy. OBJECTIVE Our main hypotheses are that LIVIA 1 (control condition) and LIVIA 2.0 (experimental condition) increase participants’ well-being and decrease their distress at posttest and at follow-up, that LIVIA 2.0 is more efficient than LIVIA 1 for all outcomes, and that LIVIA 2.0 has less dropouts than LIVIA 1. METHODS Outcomes will be assessed at pretest, posttest (12 weeks later), and follow-up (24 weeks later). We will recruit 234 participants through a variety of means, including social media and contacts with the press. Primary outcomes are grief symptoms, depressive symptoms, and eudemonic well-being. Secondary outcomes are anxiety symptoms, grief coping strategies, aspects related to self-identity reorganization, and program satisfaction. LIVIA 2.0 participants will additionally undergo a weekly mood and grief symptom monitoring, allowing us to explore the short-term efficacy of the sessions. RESULTS The creation and development of the content of LIVIA 2.0 was completed during the first phase of the project. Participant recruitment will begin in May 2022 and will last until January 2023. CONCLUSIONS This study will emphasize the relevance of the innovations included in LIVIA 2.0 regarding the efficacy and dropout rate of IBIs for grief symptoms and will allow investigations on how these changes impact the demand for guidance. In the current postpandemic times, developing and assessing IBIs targeting grief symptoms are particularly critical given the rise in grief-related symptoms. CLINICALTRIAL clinicaltrials.gov NCT05219760; https://tinyurl.com/3dzztjts INTERNATIONAL REGISTERED REPORT PRR1-10.2196/39026

Empirical evidence suggests that concentrating on patients’ internal and external strengths serves a preventative function against psychopathology. However, standardized tools assessing strengths of patients suffering from mental disorders are rare and often limited to research purposes. As current practice in mental health rarely stresses the importance of patients’ personal resources, the feasibility of strengths-based assessments has rarely been validated within such a population. We designed a new instrument, the Strengths Q-sort Self-Assessment Scale, aimed at identifying patients’ strengths profile. This new scale measures 30 strengths classified in three sections: (i) personal characteristics, (ii) hobbies/passions, (iii) environmental/social strengths. In order to be adjusted for patients with cognitive or language impairments, this instrument is based on a Q-Sort method with figurative items. The aim of this study was to test the feasibility and acceptability of this scale in a sample of 21 psychiatric patients. Preliminary results showed that this tool can easily be administered and is well appreciated by patients. Feedback from clinicians highlight the benefits of identifying the strengths profiles in order to help defining realistic shared clinical objectives based on patients’ strengths.

Introduction Doing a strength-based assessment is a therapeutic process that can foster recovery. However, standardized resources tools adapted to the specificities of patients suffering from psychiatric disorders are rare and not routinely used in mental health services. Objective Therefore, a new resources self-assessment scale (AERES) has been specifically developed for this population. The first objective of this current paper is to identify descriptive profiles of patients’ resources with the AERES. The second objective is to explore the impact of a resources assessment on patients’ self-esteem and well-being. Method This tool was administered to 213 patients suffering from severe psychiatric disorders and coming from four mental health centers in Switzerland and France. Patients’ level of self-esteem and well-being was measured before and after the administration of the AERES with the Rosenberg Self-esteem scale and the Visual analogue Scale for well-being. Results Results showed that the AERES can easily be administered with these patients and with important benefits. The most common resources found were gratitude, listening to music, and professional healthcare. The resources patients wanted to develop the most were self-esteem, travelling and friends. Results indicated an increase in self-esteem, happiness, serenity, life satisfaction and meaning in life after the patients identified their personal resources. Conclusion This tool can provide clinicians and researchers with new information regarding patients’ intact resources despite their psychopathology. This strength assessment consists in a first step of a therapeutic process. The identified resources can then be activated in order to alleviate patients’ symptoms and foster their quality of life.

Summary Is it possible to consider that cognitive-behavioral therapy is always scientific? Our response looks at this question dealing with a key element of CBT identity from three different angles: historical, epistemological and clinical; by revisiting the past, the present and finally speculating on the future. Is CBT always founded on proof rather than myths? Is CBT a real therapy for serious illnesses? Is every aspect of CBT efficient? True or false? It is urgent to examine each of these questions. Indeed, CBT could disappear, drowned in the emergence of new approaches. How can its future be envisaged? Firstly, in historical terms, the case of little Albert described by Watson and Rayner in 1920 had a founding role in the comprehension of conditioning mechanisms. However, summarizing the mechanism is fastidious, it is difficult to interpret this experiment, and replication studies give rather contradictory results. Despite this, the future of this child, the original patient, has been the object of much speculation which remains unresolved today. There are other myths surrounding CBT: for example, the “bobo doll” experiment (Bandura, Ross & Ross, 1961) which was very controversial; Beck who explained in an article in 1971 (Beck, 1971), without testing his theory, that dreams revealed a patient's schemas better than any external stimulus; and different “waves” of CBT which are still widely disparaged. On an epistemological level, proof of the efficacity of CBT treatment falls willingly on the psychiatric classifications of DSM-V and CIM-10 type. However, these classifications themselves are called into question today in favor of alternatives such as those suggested by the National Institute of Mental Health with the RDoC (Research Domain Criteria) (Insel, 2014) or also the understanding of mental disorders as a system of symptoms in interaction or in a network, “Complex Causal Network Approach”, rather than as linear dimensions or categories. A generic cognitive-behavioral conceptualization of mental disorders would be possible and compatible with this complex approach (Hofmann, 2014). Furthermore, the assessment of the efficacity of the therapy does not only rely on randomized studies. Five other approaches would be useful to develop to improve knowledge of CBT: experimental single case studies, case studies, qualitative studies, process studies and effectiveness studies. In addition, efficacity is not the only goal and it is important not to forget the effectiveness and efficiency of the treatments used. On a clinical level, CBT was first built on conditioning theories and practice based on exposure, generalization and habituation. Today, therapeutic practices are rich, diversified and sometimes even eclectic, creating a certain blur between those which belong specifically to CBT and those which have been borrowed from other approaches. They all appear to be promising, but are they really? The “dodo bird” effect could explain this phenomenon. Developing research on eclectic models, or better still on integrative concepts, would perhaps allow pruning even an opening up to new developments following the examples of the psychotherapy of schemas (Young et al. 2005) and multimodal psychotherapy (Lazarus 1981). Finally, the future is unpredictable, but three areas of reflection could be suggested: let us not forget to integrate the body into our practices, as changing also implies embodying a new way of being. Let us favor modesty as, unlike the weather forecast, change is not predetermined and depends on the ability of the patient to seize all available opportunities at the right time. Psychotherapy is a form of esthetics, as the greatest therapists were fabulous artists before becoming great scientists!

Resume La recherche empirique a montre qu’une focalisation sur les ressources des patients psychiatriques est protectrice face a une chronicisation de leurs symptomes. L’utilisation en pratique clinique d’outils standardises mesurant les ressources est neanmoins rare du fait d’un manque d’instruments adaptes. Pour pallier a cette lacune, nous avons developpe un outil d’auto-evaluation des ressources adapte aux patients psychiatriques (l’AERES). Cet outil dresse le profil general des ressources internes et externes pouvant contribuer a leur retablissement. Cet article presente l’outil AERES et analyse dix entretiens afin d’evaluer l’impact sur les patients d’une perspective centree sur le retablissement. La methode de recherche qualitative consensuelle de Hill est utilisee. Les resultats montrent que l’AERES est percu par les patients comme exhaustif, utile, comprehensible, agreable et nouveau.

Background The MacArthur Admission Experience Survey (AES) is a widely used tool to evaluate the level of perceived coercion experienced at psychiatric hospital admission. The French-language AES was prepared using a translation/back-translation procedure. It consists of 16 items and 3 subscores (perceived coercion, negative pressures and voice). This study aimed to assess the psychometric properties of the French-language AES. Methods 152 inpatients were evaluated. Reliability was estimated using internal consistency coefficients and a test–retest procedure. Internal validity was assessed using a two-parameter logistic item response model. Convergent validity was estimated using correlations between the AES scores and the Coercion Ladder (CL), the Coercion Experience Scale (CES) and the Global Assessment of Functioning (GAF) scale. Discriminatory power was evaluated by comparing the scores of patients undergoing voluntary or compulsory admission. Results The French-language AES showed good internal consistency and test–retest reliability. Internal validity of the three-factor model was excellent. Correlations between AES and CL, CES and GAF scores suggested good convergent validity. AES scores were significantly higher among patients subject to compulsory psychiatric hospital admission than among those admitted voluntarily. Conclusions Overall, the French-language version of the AES demonstrated very good psychometric proprieties.

In a political environment increasingly concerned with the problem of escalating health care costs, the issue of psychotherapy efficacy evaluation is still debated. Historically, this debate started after Eysenck (1952) published a famous article suggesting that average improvement from pre- to post-therapy has nothing to do with psychotherapy participation, but something that would tend to happen anyway ("spontaneous remission"). Wanting to prove that psychotherapy was effective (Glass, 2000), Smith and Glass (1977) published the first meta-analysis of the psychotherapy efficacy, combining the results of several controlled clinical trials, and found that psychotherapy was remarkably efficacious. Following a brief historical introduction, the objectives of this paper is to define the principles of meta-analysis, to discuss of epistemological contextualization of this methodological approach, and finally to examine the interest and limits of the application of this method in the field of evaluation of psychotherapy.

Purpose Needs assessment is recognized to be a key element of mental health care. Patients tend to present heterogeneous profiles of needs. However, there is no consensus in previous research about how patients’ needs are organized. This study investigates both general and specific dimensions of patients’ needs for care. Methods Patients’ needs were assessed with ELADEB, an 18-domain self-report scale. The use of a self-assessment scale represents a unique way of obtaining patients’ perceptions. A patient-centered psychiatric practice facilitates empowerment as it is based on the patients’ personal motivations, needs, and wants. Four seventy-one patients’ profiles were analyzed through exploratory factor analysis. Results A four-factor bifactor model, including one general factor and three specific factors of needs, was most adequate. Specific factors were (a) “finances” and “administrative tasks”; (b) “transports,” “public places,” “self-care,” “housework,” and “food”; and (c) “family,” “children,” “intimate relationships,” and “friendship.” Conclusion As revealed by the general factor, patients expressing urgent needs in some domains are also more susceptible to report urgent needs in several other domains. This general factor relates to high versus low utilizers of public mental healthcare. Patients also present specific needs in life domains, which are organized in three dimensions: management, functional disabilities, and familial and interpersonal relationships. These dimensions relate to the different types of existing social support described in the literature.

Resume De nombreuses recommandations de pratique clinique (RPC) ont ete publiees, en reponse au developpement du concept de la medecine fondee sur les preuves et comme solution a la difficulte de synthetiser et trier l’abondante litterature medicale. Pour faire un choix parmi le foisonnement de nouvelles RPC, il est primordial d’evaluer leur qualite. Recemment, le premier instrument d’evaluation standardisee de la qualite des RPC, appele « AGREE » pour a ppraisal of guidelines for research and evaluation , a ete valide. Nous avons compare – avec l’aide de la grille « AGREE » – les six principales RPC publiees depuis une dizaine d’annees sur le traitement de la schizophrenie : (1) les Recommandations de l’Agence nationale pour le developpement de l’evaluation medicale (ANDEM) ; (2) The American Psychiatric Association (APA) practice guideline for the treatment of patients with schizophrenia ; (3) The quick reference guide of APA practice guideline for the treatment of patients with schizophrenia [APA — guide rapide de reference] ; (4) The schizophrenia patient outcomes research team (PORT) treatment recommandations ; (5) The Texas medication algorithm project « T-MAP » ; (6) The expert consensus guideline for the treatment of schizophrenia . Les resultats de notre etude ont ensuite ete compares avec ceux d’une etude similaire publiee en 2005 par Gaebel et al. portant sur 24 RPC abordant le traitement de la schizophrenie, realisee egalement avec l’aide de la grille « AGREE » et deux evaluateurs [Br J Psychiatry 187 (2005) 248–255]. De maniere generale, les scores des deux etudes ne sont pas trop eloignes et les deux evaluations globales des RPC convergent : chacune des six RPC est perfectible et presente differemment des points faibles et des points forts. La rigueur d’elaboration des six RPC est dans l’ensemble tres moyenne, la prise en compte de l’opinion des utilisateurs potentiels est lacunaire et un effort sur la presentation des recommandations faciliterait leur utilisation clinique. L’applicabilite des recommandations est egalement peu consideree par les auteurs. Globalement, deux RPC se distinguent et peuvent etre fortement recommandees selon les criteres de la grille « AGREE » : « l’APA – guide rapide de reference » et le « T-MAP ».

Resume Dans le cadre d’une etude retrospective au sein d’une unite de rehabilitation, nous avons cherche a examiner le degre de respect de recommandations de pratique clinique (RPC) abordant le traitement pharmacologique au long cours de la schizophrenie, par des medecins qui n’en ont qu’une connaissance indirecte. The Expert Consensus Guideline for the treatment of schizophrenia (ECGTS) a ete retenu comme reference sur la base d’une comparaison avec cinq autres RPC principales. Sur un collectif de 20 patients, les recommandations de l’ECGTS sont totalement respectees dans 65 % des cas, partiellement respectees dans 10 % et non respectees dans 25 %, demontrant ainsi que la pratique clinique est clairement perfectible (principalement dans le traitement des symptomes psychotiques et depressifs). Cependant, le respect des RPC ne garantit pas forcement la resolution de tous les problemes cliniques rencontres : 12 patients sur 20 presentent des effets secondaires a l’evaluation clinique et pour huit d’entre eux, les recommandations a ce niveau, sont respectees. Notre etude montre cependant que le choix et l’application d’une RPC ne sont pas simples. Les RPC actuelles donnent peu ou pas d’instruments de mesure, ni de criteres precis pour evaluer les problemes cliniques auxquels elles font reference. L’avenir appartient donc a des RPC qui proposent, outre les recommandations cliniques elles-memes, les moyens de leur verification et de leur application sur le terrain.

The influence and development of behaviour analysis in French‐speaking Europe has been different in the different countries, as can be seen when comparing developments in France and in the French‐speaking parts of Belgium and Switzerland. French psychology has shown persistent reluctance towards behaviour analysis, except for a few individuals in a few institutional circles. On the other hand, Belgium has been the main centre from which behaviour analysis has propagated to the French‐speaking area as a whole. Territorial specificities both in experimental analysis and in applied behaviour analysis are described and placed in context. In general, French‐speaking Europe has not been especially receptive to Skinner's radical analysis of behaviour. Few of Skinner's books have been translated into French, as compared with other major Western languages. In none of the geographical areas being considered was psychology prepared to integrate radical behaviourism, in spite of its having important experimental deve...

Several studies have shown that source‐monitoring errors are related to verbal hallucinations in schizophrenia. An exploratory pilot study has been carried out to investigate the possibility of training patients in how to avoid errors in source‐monitoring. One patient with paranoid schizophrenia and persistent thought insertions was trained for 6 hours to use mnemonic techniques to compensate specific deficits in source‐monitoring. Results show that the patient was able to improve his performance and maintain the acquired progress at a 1‐month follow‐up assessment. These preliminary results are interesting for developing a larger controlled study of cognitive remediation of source‐monitoring deficits.

Background: Despite the effectiveness of anti-psychotic pharmacotherapy, residual hallucinations and delusions do not completely resolve in some medicated patients. Additional cognitive behavioral therapy (CBT) seems to improve the management of positive symptoms. Despite promising results, the efficacy of CBT is still unclear. The present study addresses this issue taking into account a number of newly published controlled studies. Method: Fourteen studies including 1484 patients, published between 1990 and 2004 were identified and a meta-analysis of their results performed. Results: Compared to other adjunctive measures, CBT showed significant reduction in positive symptoms and there was a higher benefit of CBT for patients suffering an acute psychotic episode versus the chronic condition (effect size of 0.57 vs. 0.27). Discussion: CBT is a promising adjunctive treatment for positive symptoms in schizophrenia spectrum disorders. However, a number of potentially modifying variables have not yet been examined, such as therapeutic alliance and neuropsychological deficits.

Summary The instrument, Assessment of Interpersonal Problem-Solving Skills (AIPSS), and the rehabilitation intervention, Training in Interpersonal Problem-Solving Skills (TIPSS), which were developed at UCLA in the USA, were adapted for a French-speaking cultural setting in Geneva, Switzerland. Pilot studies replicated the original USA findings on the AIPSS and the TIPSS. These methods were practicable with French-speaking patients and fit readily into a French cultural setting with little adaptation.

Document disponible en ligne : http://www.sciencedirect.com/science/article/pii/S0738399110003095; International audience; Objective“Michael's Game” is a card game which aims at familiarizing healthcare professionals and patients with cognitive therapy of psychotic symptoms. The present study tests the feasibility and the impact of the intervention in naturalistic settings.Methods135 patients were recruited in 11 centres. They were assessed pre- and post-tests with the Beck Cognitive Insight Scale (BCIS) and the Peters Delusion Inventory-21 items (PDI-21).ResultsData about 107 patients were included in the entire analyses. Significant improvements were observed on BCIS subscales as well as a reduction of severity of conviction and preoccupation scores on the PDI-21. The intervention has a moderate effect on the PDI-21 preoccupation and conviction as well as the BCIS subscales. Patients who benefit the most from the program are patients who have a low degree of self-reflectiveness and patients who are concomitantly preoccupied by their symptoms.ConclusionThe present study supports the feasibility and effectiveness of “Michael's Game” in naturalistic settings.Practical implicationsThe game seems to be a useful tool for patients with psychotic disorders.

There are at least six psychotherapeutic treatments of personality disorders having received empirical and clinical validation in terms of their efficacy. These treatments are based on different theoretical models, namely the cognitive-behavioural, psychodynamic and interpersonal models. This article briefly presents these treatments, focusing on the process of therapeutic change. It is assumed that the process of emotional activation is one of the most interesting theoretical psychotherapy ingredient in treatments of these patients. The treatments are discussed regarding this hypothesis and its clinical implications.

Objective: The Beck Cognitive Insight Scale (BCIS) evaluates patients' self-report of their ability to detect and correct misinterpretation. Our study aims to confirm the factor structure and the convergent validity of the original scale in a French-speaking environment. Method: Outpatients ( n = 158) suffering from schizophrenia or schizoaffective disorders fulfilled the BCIS. The 51 patients in Montpellier were equally assessed with the Positive and Negative Syndrome Scale (PANSS) by a psychiatrist who was blind of the BCIS scores. Results: The fit indices of the confirmatory factor analysis validated the 2-factor solution reported by the developers of the scale with inpatients, and in another study with middle-aged and older outpatients. The BCIS composite index was significantly negatively correlated with the clinical insight item of the PANSS. Conclusions: The French translation of the BCIS appears to have acceptable psychometric proprieties and gives additional support to the scale, as well as cross-cultural validity for its use with outpatients suffering from schizophrenia or schizoaffective disorders. The correlation between clinical and composite index of cognitive insight underlines the multidimensional nature of clinical insight. Cognitive insight does not recover clinical insight but is a potential target for developing psychological treatments that will improve clinical insight.

Background Overweight and obesity are common concerns in individuals with severe mental disorders. In particular, antipsychotic drugs (AP) frequently induce weight gain. This phenomenon lacks current management and no previous controlled studies seem to use cognitive therapy to modify eating and weight-related cognitions. Moreover, none of these studies considered binge eating or eating and weight-related cognitions as possible outcomes. Aim The main aim of this study is to assess the effectivity of cognitive and behavioural treatment (CBT) on eating and weight-related cognitions, binge eating symptomatology and weight loss in patients who reported weight gain during AP treatment. Method A randomized controlled study (12-week CBT vs. Brief Nutritional Education) was carried out on 61 patients treated with an antipsychotic drug who reported weight gain following treatment. Binge eating symptomatology, eating and weight-related cognitions, as well as weight and body mass index were assessed before treatment, at 12 weeks and at 24 weeks. Results The CBT group showed some improvement with respect to binge eating symptomatology and weight-related cognitions, whereas the control group did not. Weight loss occurred more progressively and was greater in the CBT group at 24 weeks. Conclusion The proposed CBT treatment is particularly interesting for patients suffering from weight gain associated with antipsychotic treatment.

Group cognitive-behavior therapies in the treatment of anxiety disorders for adult psychiatric patients were historically developed on the basis of validated individual treatments. They have been widely employed and studied for social phobia, panic disorders, agoraphobia and obsessive-compulsive disorders, with generally positive results similar to those obtained with the corresponding individual methods. The cognitive-behavioural group treatments for generalized anxiety and posttraumatic stress disorders have not yet received sufficient validation. The results of evaluative research show that the format of the therapy (individual or group) does not appear to predict the outcome. Therefore an indication for an individual or a group therapy cannot be made on the basis of the diagnosis alone. It has to be based on other criteria, in particular economical, organisational or clinical. Group therapies can certainly offer advantages in comparison with individual procedures, even if they cannot always fit perfectly the specific needs of every patient. Indication has to be made individually, in order to allow the therapists to judge their patients' capacities and interest to participate in a group program.

The integrated psychological treatment for schizophrenic patients IPT is composed by six modules that can be implemented either separately or in an articulated way. In that case, the treatment begins with a cognitive remediation phase which is followed by a social skills training phase. In the first phase, exercises specifically focalize on selective attention, memory, logical reasoning, perception and communication skills. The second phase of the program offers three other modules that train other skills: 1) social skills, 2) emotional management, 3) interpersonal problem solving. The IPT program belong to the so called second generation of social skills training programmes. It has been validated by numerous controlled studies, either in its complete form or in partial forms containing only one ore more of its sub-programmes. The results of these studies are globally positive. They show that IPT is an interesting therapeutic contribution for the rehabilitation practice with schizophrenic patients. A third generation of social skills training has been elaborated on the basis of the current IPT program. These new adjunctions to the IPT tend to favour the utilization in the real life of the competencies trained in the sessions, either by adding specific homeworks, in-vivo or booster sessions, or by designating new programmes directed to specific rehabilitation objectives, such as the integration in a apartment, the management of leisure times or the return to a workplace. These new programmes have been studied. They are promising and seem to be a useful complement to the original IPT.

During the past 20 years, therapeutic and rehabilitative modalities in the field of psychosocial rehabilitation have been diversified in becoming more specific. We have the possibility to offer individualized rehabilitation programs as well as in the general field of socio-professional goals as in the clinical field according to the patients' needs and personal assets. The content of these programs associates various forms of specialized medical and paramedical services. The indications are established trough a careful assessment. The rehabilitation unit of the University Department of Psychiatry in Lausanne has developed a multidisciplinary assessment method based on the bio-psychosocial integrative model and the vulnerability-stress model in integrating the level of experience of Wood for the analysis of the psychosocial functioning. This results in a structured assessment program, which leads to a multidisciplinary comprehensive assessment (difficulties versus adaptative resources).

The aim of this study is to test the feasibility and the efficacy of a cognitive and behavior therapy manual for auditory hallucinations with persons suffering from schizophrenia in a French-speaking environment and under natural clinical conditions. Eight patients met ICD-10 criteria for paranoid schizophrenia, 2 for hebephrenic schizophrenia and 1 for schizoaffective disorder. All were hearing voices daily. Patients followed the intervention for 3 to 6 months according to their individual rhythms. Participants filled up questionnaires at pre-test, post-test and three months follow-up. The instruments were the Belief About Voice Questionnaire--Revised and two seven points scales about frequency of hallucinations and attribution of the source of the voices. Results show a decrease of voices' frequency and improvement in attributing the voices rather to an internal than to an external source. Malevolent or benevolent beliefs about voices are significantly decreased at follow-up as well as efforts at coping with hallucinations. Results should be interpreted with caution because of the small number of subjects. The sample may not be representative of patients with persistent symptoms since there is an over representation of patients with benevolent voices and an under representation of patients with substance misuse.

The main goal of psychosocial rehabilitation is to compensate the vulnerability underlying psychiatric disorders through intermediate institutions when the persistence and recurrence of these disorders have led to social and professional exclusion. Intermediate institutions refer to services which allow transition between the state of dependence on the hospital to the state of relative autonomy in social community. Psychosocial rehabilitation is a comprehensive approach which link the type of interventions: treatment, rehabilitation and support integrated in multimodal and individualized programs. A study of the out-patients followed by the rehabilitation unit of the psychiatric department in Lausanne has shown that provision of services is divided into 60% for rehabilitation, 20% for treatment and 20% for support independently of the psychiatric disorders. The implementation of these programs necessitates institutional support from psychiatric hospital to outpatient clinics through different types of facilities in order to offer a medical and psychosocial device of rehabilitation into the community.

Il existe de multiples instruments d’evaluation du fonctionnement social, de la qualite de vie ou des besoins des patients psychiatriques qui peuvent aider dans l’elaboration des strategies de traitement. Neanmoins, nombre d’entre eux ne repondent pas toujours aux attentes des cliniciens ou des chercheurs. En reponse a ces limitations, nous avons elabore une nouvelle echelle de mesure subjective des difficultes et du besoin d’aide, intitulee ELADEB. Sur la base d’une activite de tri de cartes, il est possible en quelques minutes de dresser le profil de difficultes des patients, et de mettre en evidence les domaines dans lesquels ils estiment avoir besoin d’une aide supplementaire par rapport a celle qui existe peut-etre deja.

Patients with antipsychotic-induced weight gain (WG) regularly report on unsuccessful dietary trials, which suggests strong biological weight gain drive that is extremely hard to overcome with thoughts, such that behaviour doesn't change despite some intent to change. The purpose of the present study was to assess cognitions specifically related to restrained eating in severely overweight patients with schizophrenia treated with antipsychotic drugs. Forty outpatients with schizophrenia and 40 controls without psychiatric disability were included. Both groups were composed of one subgroup severely overweight (defined as a BMI > 28), and a comparison sample (BMI

Cet article propose une demarche exploratoire visant a comparer, a l'aide d'une grille de lecture psychanalytique, trois formes de processus psychotherapique : psychanalytique, systemique et cognitif-comportemental. Trois situations de consultation en rapport avec un conflit conjugal ont ete attribuees a trois psychotherapeutes formes chacun dans l'un des modeles etudies. Une transcription de l'entretien a ete effectuee afin de permettre d'etudier comment chaque professionnel traite la demande du patient en rapport avec le conflit conjugal narre par ce dernier. Du point de vue de la theorie des relations d'objet et de la notion d'etayage objectal, il est possible de mettre en evidence des options strategiques clairement differentes entre les trois therapeutes, notamment dans la maniere de prendre position par rapport aux dimensions intersubjective, interpersonnelle ou cognitive du conflit conjugal decrit par le patient. Les implications de cette demarche exploratoire sur le plan therapeutique et de la recherche sont discutees.

Six traitements psychothérapiques des troubles de personnalité sont brièvement présentés dans cette revue de la littérature. Ces traitements se basent sur des modèles théoriques différents, les approches cognitive-comportementale, psychodynamique et interpersonnelle et ont déjà fait leurs preuves cliniques et empiriques en termes de leur efficacité. Se centrant sur les processus de changement thérapeutique, les auteurs émettent l’hypothèse que le processus d’activation émotionnelle est l’un des ingrédients les plus intéressants de ces traitements. Les traitements sont discutés sous l’angle de cette hypothèse et de ses implications cliniques., There are at least six psychotherapeutic treatments of personality disorders having received empirical and clinical validation in terms of their efficacy. These treatments are based on different theoretical models, namely the cognitive-behavioural, psychodynamic and interpersonal models. This article briefly presents these treatments, focusing on the process of therapeutic change. It is assumed that the process of emotional activation is one of the most interesting theoretical psychotherapy ingredient in treatments of these patients. The treatments are discussed regarding this hypothesis and its clinical implications., En esta revisión de la literatura se presentan brevemente seis tratamientos psicoterapéuticos de los trastornos de la personalidad. Estos tratamientos se basan en modelos teóricos diferentes, los enfoques cognitivo-comportamentales, psicodinámicos e interpersonales, cuya eficacia ya ha sido probada clínica y empíricamente. Al centrarse en los procesos de cambio terapéutico, los autores plantean la hipótesis de que el proceso de activación emocional es uno de los componentes más interesantes de estos tratamientos. Los tratamientos se discuten bajo el punto de vista de esta hipótesis y sus implicaciones clínicas., Seis tratamentos psicoterápicos dos transtornos de personalidade são apresentados brevemente nesta revista da literatura. Estes tratamentos baseiam-se em modelos teóricos diferentes, abordagens cognitivo-comportamental, psicodinâmica e interpessoal, e já passaram por provas clínicas e empíricas com respeito à sua eficácia. Concentrando-se nos processos de mudança terapêutica, os autores levantam a hipótese de que o processo de ativação emocional é um dos ingredientes mais interessantes destes tratamentos. Os tratamentos são discutidos sob o ângulo desta hipótese e destas implicações clínicas.