Une théorie des réseaux des troubles mentaux

In recent years, the network approach to psychopathology has been advanced as an alternative way of conceptualising mental disorders. In this approach, mental disorders arise from direct interactions between symptoms. Although the network approach has led to many novel methodologies and substantive applications, it has not yet been fully articulated as a scientific theory of mental disorders. The present paper aims to develop such a theory by postulating a limited set of theoretical principles regarding the structure and dynamics of symptom networks. At the heart of the theory lies the notion that symptoms of psychopathology are causally connected through myriads of biological, psychological and societal mechanisms. If these causal relations are sufficiently strong, symptoms can generate a level of feedback that renders them self-sustaining. In this case, the network can get stuck in a disorder state. The network theory holds that this is a general feature of mental disorders, which can therefore be understood as alternative stable states of strongly connected symptom networks. This idea naturally leads to a comprehensive model of psychopathology, encompassing a common explanatory model for mental disorders, as well as novel definitions of associated concepts such as mental health, resilience, vulnerability and liability. In addition, the network theory has direct implications for how to understand diagnosis and treatment, and suggests a clear agenda for future research in psychiatry and associated disciplines.     

Sur la régulation neurovégétative des petits vaisseaux du péritoine

Journal of Neural Transmission -     

L’évaluation des répercussions fonctionnelles des altérations de la cognition sociale favorise-t-elle l’engagement dans les soins des personnes ayant des troubles psychotiques ?

Objective

Cognitive impairments and particularly social cognitive deficits are present from the early stages of schizophrenia. With other factors such as motivation, metacognitive processes and insight, social cognition appeared as having an essential role in the genesis of psychosocial disability of patients suffering from this disease. Furthermore, it seems that interventions which meet the specific needs of users, despite both the uncertainly of the diagnosis and the lack of insight, have been identified as a determinant factor to reduce the period of untreated psychosis and thus favoring long-term prognosis. The study here aims to observe if the assessment of functional outcomes of social cognitive impairments, thanks to a semi-structured interview (Social Cognition-Functional Outcomes Scale ERF-CS), could favor involvement of people with psychosis in their health care, by encouraging motivation and therapeutic alliance. The ERF-CS is composed of 14 items that depict different social situations in which each component of social cognition is likely to have an impact. The scale provides qualitative information on difficulties lived by patients in social situations in the daily life and an overall score of functional outcomes ranging from 0 to 154. The questionnaire took around one hour to complete.

Le rôle des facteurs psychologiques dans la réalisation d’une démarche de dépistage du VIH

Objectives

Despite of regional, national and international plans which have been implemented to struggle against the Human Immunodeficiency Virus (HIV), the global prevalence of this disease continues to increase. While the General Assembly of the United Nations is aiming at putting an end to the Acquired Immune Deficiency Syndrome (AIDS) epidemic in the world by 2030, it appears necessary to draw up the list of the main factors involved in the HIV test process. Indeed, a better knowledge of the factors, facilitating or hindering the uptake of a HIV screening test, enables to make more effective prevention campaigns which aim at improving people's knowledge of their serological status. The purpose of this article is to underline the impact of psychological factors involved in the HIV test process. From the literature reviews already established, the main psychological factors, facilitating or hindering the uptake of a HIV screening test have been identified.

Amélioration des paramètres spatio-temporels de la marche par le renforcement musculaire des membres inférieurs chez des enfants atteints de paralysie cérébrale spastique

PurposeCerebral palsy is the most common motor impairment in children, with a prevalence ranging from 1.5 to 3.8 per 1000 births from one country to another. Many studies highlight the benefits of physical activity in cerebral palsy. Here we study its impact on the spatio-temporal parameters of walking.Material and methodsThe search was conducted on PubMed with the keywords « Cerebral Palsy », « Exercises » and « Walking ». Fourty-nine articles were studied and 5 were selected to be analysed in depth. The study population comprises of children and teenagers with spastic cerebral palsy aged 6 to 16. The targeted intervention is the strengthening of lower body muscles through various exercises with and without specific equipment.ResultsSamples range from 15 to 30 children aged 6 to 16. GMFCS scores range from I to IV. The exercises are offered 3 to 5 times a week with an exercise duration of 25 to 70 min per session. The studies were conducted for 6 to 12 weeks. Different measurement scales were used, one before and one after the intervention. Two studies used a third measure one month before the intervention.ConclusionAn improvement in the spatio-temporal parameters of walking was observed in all studies; more specifically in walking speed, step length and walking rate. The limitations of these studies are that the samples are small and very heterogeneous. The long-term benefits of these interventions would also be interesting to study.     

Innervation cérébrospinale et neurovégétative des muscles striés en circonstances normales et pathologiques

Résumé La dégénérescence des plaques motrices, causée par voie cérébrospinale et neurovégétative, a été étudiée entre autres au moyen de la technique acétylcholinestérasique et celle de Champy-Coujard chez le rat et le lapin. En outre, des biopsies musculaires chez les patients neurologiques ont été examinées. Jusqu'ici nous n'avons pas réussi à trouver chez ces patients une relation intime entre le diagnostic clinique et les anomalies observées dans les préparations. Chez quelques patients la présence des plaques motrices anormales a pu aider à formuler un diagnostic bien déterminé, qui n'avait pu l'étre au moyen des méthodes cliniques et histologiques habituelles. Il ne paraît pas exister une relation directe entre le degré de paralysie et les anomalies des plaques motrices lors de l'irritation du plexus pelvicus au moyen de phénol.Cependant, nous avons pu constater une innervation anormale dans les expériences précitées et chez les patients au moyen de la technique de Champy-Coujard. Dans les biopsies musculaires normales et pathologiques, traitées selon Champy-Coujard, des plaques motrices noires ont souvent été observées.

---

Summary Degeneration of motor endplates, caused by cerebro-spinal and neuro-vegetative interventions, has been studied in rat and rabbit especially with the aid of the acetylcholinesterase technic and the Champy-Coujard reaction. On the other hand, muscle biopsies of neurological patients have been examined. Untill now, we have not been able to find in these patients an intimate correlation between the clinical diagnosis and the anomalies observed in the preparations. In a few cases the presence of abnormal motor endplates was an indication for a well definite diagnosis, a diagnosis which with the aid of the usual clinical and histological methods could not have been ascertained. There seems to be no direct relation between the degree of paralysis and the abnormalities of the motor endplates in rabbit after irritation of the plexus pelvicus by means of phenol. With the Champy-Coujard reaction, in most cases it was found that an abnormal adrenergic innervation exists, as well in these experiments as in the patients. In normal and in pathological muscle biopsies stained by the reaction of Champy-Coujard we often observed black motor endplates.

---

Zusammenfassung Die auf cerebrospinalem und neurovegetativem Wege verursachte Degeneration der motorischen Endplatten wurde bei Ratten und Kaninchen unter anderem mit der Acetylcholinesterase und der Champy-Coujard-Technik untersucht. Außerdem untersuchten wir Muskelbiopsien von neurologischen Patienten. Bisher ist es uns nicht gelungen, bei diesen Patienten eine enge Beziehung zwischen der klinischen Diagnose und den in den Präparaten gefundenen Anomalien zu beobachten. Bei einigen Patienten war es möglich, aus dem Vorhandensein abnormaler motorischer Endplatten eine Diagnose zu stellen, welche mit Hilfe der üblichen klinischen und histologischen Methoden nicht mit Sicherheit gestellt werden konnte. Es ließ sich bei unseren Experimenten, bei welchen der Plexus pelvicus mit Phenol irritiert wurde, keine direkte Beziehung zwischen dem Grade der Paralyse und den Abweichungen der motorischen Endplatten nachweisen. Wohl konnten wir bei diesen Experimenten und bei den Patienten eine abnormale Innervation mit der Champ-Coujard-Methode feststellen. Schwarze motorische Endplatten wurden oft in Champy-Coujard-Präparaten sowohl in normalen als pathologischen Muskeln beobachtet.

---

---

Chirurgien à Amstelveen

---

Avec 28 Figures

---

Les recherches histologiques ont été faites sous la direction du Prof. Dr.H. A. Meyling, Institut d'Anatomie Vétérinaire, Utrecht. Pour une partie de cette recherche une subvention a été versée par la Communauté Européenne du Charbon et de l'Acier, à Luxembourg.     

Sur la régulation neurovégétative de territoire et de système des vaisseaux

Résumé Les variations réflexes du tonus vasculaire, provoquées par la stimulation directe des vaisseaux, peuvent s'étendre à tous les vaisseaux d'un territoire vasculaire, ou bien se produise seulement dans les limites du système vasculaire stimulé; autrement dit il existe un réflexe vasculaire de territoire et un réflexe vasculaire de système. Il semble que les réflexes de territoire puissent être provoqués par la stimulation de l'adventice des artères et des veines, tandis que les réflexes de système semblent répondre à des stimulations de l'intime.

---

Summary The reflex variations of the vascular tonus which may be caused by direct stimulation of the vessels may affect all the vascular sections or be limited to the regional vessels. We have namely a regional reflex and a systemic reflex. The regional reflex seems to be caused by stimulation of the arteries or veins adventitia, while the system reflexes seems to be caused by stimulation of the intima.

---

Zusammenfassung Die reflektorischen Veränderungen des Gefäßtonus, die durch direkte Reizung der Gefäße hervorgerufen werden, können entweder alle entsprechenden Gefäße des Kreislaufsystems betreffen oder nur auf die des gereizten Bezirkes beschränkt bleiben.Man kann also einen regionalen und einen Systemreflex unterscheiden. Die regionalen Reflexe scheinen durch Reizungen der Adventitia ausgelöst zu werden, während die Systemreflexe mehr durch eine Reizung der Intima verursacht scheinen.

---

Riassunto Le variazioni riflesse del tono vasale, provocabili con stimolazioni dirette dei vasi, possono estendersi a tutti i vasi di un territorio vasale, come possono verificarsi nei limiti del sistema vasale stimolato; si ha cioè un riflesso di territorio vasale e un riflesso di sistema vasale. I riflessi di territorio sembrano provocabili con stimolazioni dell'avventizia delle arterie e delle vene, mentre i riflessi di sistema sembrano provocabili con stimolazioni dell'intima.

---

---

Avec 8 figures     

Qu’en est-il de l’équilibre psychique des enfants réfugiés ?

ObjectiveThe aim of this study is to determine to what extent the psychological balance of Syrian refugee children in Lebanon can be altered. Our goal is to identify the influence of the children's history and their current living conditions on their psychological balance. War refugees, and more particularly children and young adolescents, experience different crises and traumas linked to war, loss, exile, poor living conditions and integration in the host country. The current issue and the various researches that have been carried out have led to several questions about the impact that the war experience, the migratory history and the living conditions of these children can have on their psychological balance. The main questioning which therefore guides this research project is whether the psychological balance of these Syrian refugee children is altered and if so, to what extent. We have seen from the literature that studies on war refugees are rather rare. Immigrant populations in European populations are those that are generally studied because of their proximity and the relative ease of making contact, which is not the case in refugee camps. This is all the accurate for Lebanon, a country which, as we have seen, lacks any framework, procedure and structure relating to the organized reception of refugees. The main hypothesis of this research is that Syrian children living in more precarious living conditions and having a past history marked by potentially traumatic events, will have a less developed mental balance than others.Materials and methodsTwo groups of Syrian children living in Lebanon, aged between 8 and 12 years old, took part in this study. One of the groups being made up of children living in refugee camps and the other one made up of non-refugee children, living in conditions similar to their own in Syria. This research includes both girls and boys. All the children are of Syrian nationality, grew up in Syria and currently live in Lebanon. The collection of information and the study of the influence of the migratory experience of war and the living conditions of the children on their psychological balance, were carried out by means of three main tools: A semi-structured clinical interview available in three languages (in French, English and Arabic). A post-traumatic stress symptom rating scale was included in the questionnaire, the CRIES-13, which is an assessment questionnaire designed to measure the impact of events on children, and the free drawing test was proposed, followed by a survey following the child's production, analyzed from the model of Georges and Anna Cognet.ResultsThe collected data made it possible to observe an alteration in the psychological balance of Syrian refugee children, as well as significant differences between the two groups of children who participated in the study.ConclusionsThis is a study with a population that has so far not aroused much interest, despite the multitude of migratory crises of our century on all continents, and which could contribute to the assessment and the care of immigrant or displaced populations all over the world. Indeed, in view of the results obtained, the research contributes to the need for refugee support by countries and supranational organizations having the means or the responsibility to do so. The question of the consequences of the living conditions of refugees in the long term arises with the imperative, as a health professional, to find means of logistical, physical and in particular psychological care, for this fragile and large population. need for appropriate follow-up and support.     

Intérêts et limites des hospitalisations séquentielles dans la prise en charge des états de stress post-traumatique

Beyond emergency, many patients with Post-Traumatic-Stress-Disorder may evolve into a lasting alteration of their previous health status consisting of polymorphic and durable psychiatric symptomatology. In the Army, the path of these « psychic wounded » is accompanied by different institutional services from recognition to rehabilitation. Thinking the long term psychiatric accompaniment of these patients recquires to question the place of the different interlocutors. In this works we make a feedback about a sequential hospitalization experience taking place in an Army Instruction Hospital by questioning the contributions as the limits. We emphasize notably the difficulty of empirically establishing and reproducing the validity of an therapeutic intervention.     

Revue de la littérature récente sur les neuropathies héréditaires

The recent literature included interesting reports on the pathogenic mechanisms of hereditary neuropathies. The axonal traffic and its abnormalities in some forms of Charcot-Marie-Tooth (CMT) disease were particularly reviewed by Bucci et al. Many genes related to CMT disease code for proteins that are involved directly or not in intracellular traffic. KIF1B controls vesicle motility on microtubules. MTMR2, MTMR13 and FIG4 regulate the metabolism of phosphoinositide at the level of endosomes. The HSPs are involved in the proteasomal degradation. GDAP1 and MFN2 regulate the mitochondrial fission and fusion respectively and the mitochondial transport within the axon. Pareyson et al. reported a review on peripheral neuropathies in mitochondrial disorders. They used the term of “mitochondrial CMT” for the forms of CMT with abnormal mitochondrial dynamic or structure. Among the new entities, we can draw the attention to a proximal form of hereditary motor and sensory neuropathy with autosomal dominant inheritance, which is characterized by motor deficit with cramps and fasciculations predominating in proximal muscles. Distal sensory deficit can be present. The gene TFG on chromosome 3 has been recently identified to be responsible for this form. Another rare form of axonal autosomal recessive neuropathy due to HNT1 gene mutation is characterized by the presence of hands myotonia that appears later than neuropathy but constitute an interesting clinical hallmark to orientate the diagnosis of this form. In terms of differential diagnosis, CMT4J due to FIG4 mutation can present with a rapidly progressive and asymmetric weakness that resembles CIDP. Bouhy et al. made an interesting review on the therapeutic trials, animal models and the future therapeutic strategies to be developed in CMT disease.     

L'Anatomo-physiologie du complexe hypothalamo-hypophysaire considéré dans ses relations avec le métabolisme des glucides

Summary The whole of correlations reported in this work may be summarized in the following way:Among all the nervous formations the hypothalamus plays a predominant rôle by its hypophyseo-regulative and upper orthosympathetic centers. The exact functional localization of numerous partial mechanisms controlled by it could not yet be attained. The various hypothalamic centers are subordinate to the allocortex the isocortex the striated formations, the thalamus, and other segments of the enlarged infrathalamus. Many types of reflexes producing hypo- and hyperglycemia may be known in advance.Thus one has to take into consideration the neuroendocrine and neuroergonal systems of sugar metabolism as a whole without neglecting the rôle of the sugar producing organs, such as liver and musculature. The liver plays an important part in glycogenesis and glycogenolysis and in the metabolism of the steroid hormones. In this respect we are able to point to a case which we have examined together withRocha Brito. It is the case of a diabetic who was suffering from this disease for 23 years. He became hypoglycemie afterhepatocirrhosis from glycemic coma and died after injection with 10 units of insulin. Besides the cirrhosis he was found to be affected with atrophy of the testicles combined with hypertrophy of the interstitial glands and with insuloma due to hyperregeneration. The liver contained glycogen. It may be presumed that the insular hyperregeneration is caused by hyperfolliculinia due to an insufficiency of the metabolism of the genital steroids.In spite of the multiple correlations between the different segments of which the endocrine system is composed they maintain a certain reactional independence.So the anterior lobe of the hypophysis and the islets ofLangerhans may directly react to modifications of glycemia and biological aggressions may provoke disturbances of sugar metabolism by selectively affecting a nervous center or an endocrine gland. This occours in the case of alloxandiabetes. Nicotine hyperglycemia, which we have examined together withBonifacci, disappears in guinea-pigs after double surrenalectomy.

---

Zusammenfassung Die Gesamtheit der in dieser Arbeit behandelten wechselseitigen Beziehungen kann in folgender Weise zusammengefaßt werden:Unter allen Abschnitten des Nervengewebes spielt der Hypothalamus durch seine hypophysenregulatorischen und seine kranialen orthosympathischen Zentren eine beherrschende Rolle. Die genaue funktionelle Lokalisation zahlreicher von ihm beherrschter Teilmechanismen ist aber bis jetzt noch nicht gelungen. Die verschiedenen hypothalamischen Zentren sind dem Allocortex, dem Isocortex, den Striatum-Formationen, dem Thalamus und anderen Segmenten des erweiterten Infrathalamus untergeordnet. Viele Arten von Hypo- und Hyperglykämie erzeugenden Reflexen können im voraus erkannt werden.Man muß also das neuroendokrine und neuroergonale System des Zuckerhaushaltes in seiner Gesamtheit berücksichtigen, ohne dabei die Rolle der zuckerbildenden Organe, wie Leber- und Muskulatur, zu übersehen. Die Leber spielt eine wichtige Rolle bei der Glykogenbildung und bei Glykogenverbrauch sowie im Stoffwechsel der Steroidhormone. In dieser Hinsicht können wir einen Fall zitieren, den wir kürzlich zusammen mitRocha Brito untersucht haben. Dabei handelte es sich um einen Diabetiker, der schon 23 Jahre an dieser Krankheit litt; er wurde nach einer Lebercirrhose hypoglykämisch und starb nach Injektion von 10 Insulineinheiten an hypoglykämischem Koma. Außer der Cirrhose wurde bei ihm eine Hodenatrophie mit Hypertrophie der interstitiellen Drüse und ein durch Hyperregeneration entstandenes Insulinom festgestellt. Die Leber enthielt Glykogen. Es ist denkbar, daß die insuläre Hyperregeneration einer Hyperfollikulinie zuzuschreiben ist, entstanden durch Stoffwechselinsuffizienz der Genitalsteroide.Trotz der vielfachen wechselseitigen Beziehungen zwischen den verschiedenen Segmenten, aus denen sich das neuroendokrine System zusammensetzt, bewahren diese eine gewisse Unabhängigkeit der Reaktionen.So können der Vorderlappen der Hypophyse und dieLangerhansschen Inseln direkt auf Modifikation der Glykämie reagieren und biologische Agressionen können Störungen des Zuckerstoffwechsels dadurch hervorrufen, daß ein Nervenzentrum oder eine endokrine Drüse selektiv angegriffen wird. Das ist der Fall beim Alloxandiabetes. Nikotinhyperglykämie, die wir zusammen mitBonifacci untersucht haben, verschwindet bei Meerschweinchen nach doppelter Surrenalektomie.

---

---

Avec 36 figures     

Comment se libérer des souffrances mentales. Qu’est-ce que la résilience ?

Why and how do minds suffer? The prior and existing clinical classification and psychopathology cannot treat the suffering mind in an integrated way. In this article, resilience will be discussed at both invisible (mind) and visible (brain) level in relation to healing of the suffering mind. Our theory of neo organodynamism allows us to recognize the mental state as a spectrum ranging from a healthy to a pathological mental state. This theory seeks to eradicate prejudice against mental illness by highlighting the fact that anyone can become psychotic if they placed at the same environment and/or stress. How does the mind as a metaphysical entity can have an effect on the brain as a material entity? To answer this question, we have proposed the theory of psychiatric monistic parallelism. We wondered about the consciousness in its intrinsic definition through approach to life as a fundamental particle. The use of the weak measurement in quantum mechanics that can obtain the information of a mental state without disturbing its state allows us to reach their individual virtuality. The resilience is considered as the power of restoration of the mind-body complex and the spontaneous power of remission. In other words, considering the resilience as the visible level (the brain) and the invisible level (mind) makes possible to gain the key for cure from a pathological mental state. For this, we must understand first what the mental disorder is. The psychosis is the synaptic disorder as the visible result, but its true origin is in the mind. The mind cannot get sick. We do not know all the elements that constitute the mind as itself. The environment influences the neural network of the brain by sensory perceptions (quantum potential), then the psychotic symptoms are observed. The environment determines the dynamism of the neural network. Although the mind seems to be dominated by uncertainty, the influence of the environment can act and change the mental state. Thus, the mental state is constantly changing depending on the surrounding environment. Therefore, we can see that all mental disorders are spectrum of the mental state. According to our theory of psychiatric monistic parallelism, the event changes the magnetic field strength and makes appear an individual virtuality. The mind is thus transformed into a function of the modified strength in the magnetic field, it is called “Intensité”. The “Intensité” can act directly on brain cells by changing the potential of the neuronal cell membrane. Thereby, the “Intensité” influences the metabolism of brain cells. The mental transformation that is caused by the change in the environment may be occurred as a result of a changed state of the potential of the network of neural circuit and of a modification of the strength of an individual magnetic field (the “Intensité”). The mind (the invisible entity) and brain (the visible entity) can be considered as a magnetic material, and mutually interact each other through this magnetic effect. The “Intensité” moves on the spectrum of psychic state. Therefore, the change of the mental state is the change of the “Intensité”. The “Intensité” that undergoes the influence of the mental state varies depending on the degree of disorder of the meta-noesis. The mental state varies between a healthy state and a psychopathological state, following the organic degeneration caused by various influences such as stress. The displacement of the “Intensité” to the upstream in the spectrum of mental state is called resilience, or spontaneous remission. And its downstream displacement is considered the worsening of the mental state. The “Intensité” itself can become either the aggravating factor of the mental state or the engine of the resilience. At the visible level of the resilience, the basis of mental transformation is mainly the remodeling of the GABAergic neural network. In other words, before the reorganization of the pathogen synapse fixed by neuronal accessory pathways formed by stress stimuli, it is needed for the resilience that restoring original neuronal conduction of the main neural network must be primarily carried out. In this meaning, we must focus on the rehabilitation and the repetition of learning and activities for the visible level of resilience. This is the mechanism of resilience or spontaneous remission in the visible and invisible level.