L’évaluation des bains thérapeutiques dans la prise en charge de la douleur des enfants polyhandicapés en SSR pédiatrique

Pain management for children who have severe neurological diseases (polyhandicap), in a pediatric post-acure care and rehabilitation, is daily and work frequently with palliative approach. Cares for these children, with complex illness are a multidisciplinary approach. Treatments establishment or equipment, intervention, adaptation take place with respect and comfort concern about child or adolescent dignity. For this, drug free techniques are more and more integrated in the pain management in hospitals. Balneotherapy is one of them, essentially used for orthopaedic, rhumatological or neurological diseases (hemiplegia for example). Caregivers doesn’t have specific bath for balneotherapy in our establishment, that why we put in place some bath, called “therapeutic bath” or “relaxation bath”. The impression was a better feeling of comfort and better-being on these children. This encourages us to pursue the study to evaluate the real benefits.     

Approche psychométrique de la métacognition : étude pilote en population clinique

Background

Metacognition describes the process of thinking about one's own thought processes. This concept was introduced by Flavell in 1979 and has since been widely developed in the cognitive approach to mood and anxiety disorders. As it happens, many recent studies have underlined the links between metacognition and anxio-depressive symptoms, pointing out the interest of assessing its various dimensions. The short form of the Metacognitions Questionnaire is a brief multidimensional measure of a range of metacognitive processes and metacognitive beliefs about worry and cognition relevant to the vulnerability to and the maintenance of emotional disorders. The aim of this study was twofold: firstly to adapt and validate a French version of the short form of the Metacognitions Questionnaire (MCQ-30) and to assess its psychometric properties in a clinical sample, and secondly to investigate metacognitive predictors of anxiety and depression in this sample.

Psychotraumatologie de la guerre en Ukraine : la question de la prise en charge psychologique des victimes réfugiées ou restées en Ukraine

The war in Ukraine is a major poly-traumatic event, which leads to massive population displacements. The question of the evaluation and psychological care of psychotraumatised people is an urgent matter. As many countries hosting refugees are well endowed with a number of psychologists, some of these interested professionals should mobilise themselves and make themselves known to carry out these clinical acts. Priority should be given to trained and experienced psychologists to support victims. The language barrier will have to be overcome. Initially, it would be desirable to make contact or get closer to local and national refugee centres to facilitate these operations. Face-to-face or remote consultations, as developed during the Covid-19 pandemic, are possible. Reinforcements of available and dedicated psychologists, including remotely, from the countries hosting the most refugees are also desirable. The issue of detection, assessment and care of psychologically traumatised people who remained in the Ukrainian territory is probably even more massive. Whether non-combatants or combatants, part of the international psychological community should mobilise, in addition to local colleagues, to provide them with this psychological help. These humanitarian actions would be feasible depending on the evolution of the conflict. Whether it is psychological support for refugees or people still on the Ukrainian soil, models for organizing and coordinating these actions must be carefully thought out and implemented in an evolving way to optimise their effectiveness.     

Comparaison des bénéfices médico-économiques des antipsychotiques dans la prise en charge de la schizophrénie en France

Introduction

The course of schizophrenia can vary widely, and patients experience remission phases alternating with relapse episodes, which generally lead to hospitalisation and have a significant impact on the burden of disease. The prevalence of schizophrenia in France is estimated to be approximately 600,000 people, with an incidence of 10,000 new patients per year. Patients with schizophrenia represent the largest group of hospitalised patients in French public institutions and specialised centres, and the French authorities recognise that the management of schizophrenia is a major public health concern. The Haute Autorité de Santé (HAS) and most of the evidence-based guidelines for the maintenance treatment of schizophrenia recommend long-acting injectable (LAI) antipsychotics to be used predominantly in the prevention of relapse for non-compliant patients; however, in clinical practice, the use of LAIs remains low.

Rééducation oculomotrice informatisée dans la dyslexie : essai clinique randomisé en crossover en population pédiatrique

Objective

Several studies have reported abnormal oculomotor capacities leading to reading/writing difficulties among dyslexic children. However, no randomized clinical trial has been conducted to determine whether oculomotor training improves reading/writing skills of these children. The present study aims to evaluate the efficacy of computer-based oculomotor training among dyslexic children.

Les enfants à haut potentiel en difficulté : apports de la recherche clinique

We have been sensitized to children with high intellectual potential (HIP) having difficulties given the number of children consulting in our outpatient medico-psychological centres for scholastic problems (possibly leading to school failure), anxiety disorders or behavioral disorders such as attention deficit/hyperactivity disorder (ADHD), and in which a high intellectual potential was discovered during psychological assessments. It is the contrast, and more precisely the paradox, between the high intellectual potential of these children and their scholastic difficulties (including school failure), and the psychic suffering expressed by some of them, which led us to question, challenge and propose therapeutic and educational care adapted to these children. It is in this context that we created in December 2005 the CNAHP (National Center for Assistance to High Potential children and adolescents) which is a public centre integrated into the hospital-university department of child and adolescent psychiatry at Rennes. It is noteworthy that not all children with HIP have difficulties, and children with school failure or behavioral problems are not always children with HIP. However, it is necessary not to minimize the problem raised by children with HIP with difficulties by ignoring its frequency or by considering that these children are “intelligent” enough to manage by themselves and do not need to be helped, whereas some of them can show school failure and even be de-scholarized. Indeed, based on the definition of the World Health Organization (WHO) of an intellectual Quotient (IQ) above 130 (level corresponding to a statistical threshold), the frequency of children with HIP represents 2.3% of the population of schoolchildren aged 6 to 16. The frequency is therefore not so rare. However, it remains to be determined by French epidemiological studies what is the actual frequency of children with difficulties within a population of children with HIP. The analysis of the CNAHP research data from a clinical population (children with HIP consulting for difficulties) highlights that children with HIP can show major school problems (including school failure, defined here as having or foreseeing repetition of a grade), which corresponds to 7.5% of 611 children with HIP consulting at the CNAHP) and socioemotional problems (emotional regulation disorders) in relation to their high intellectual potential. In particular, anxiety disorders were the most frequent psychiatric disorders observed in this population (40.5%) and were significantly associated with high verbal potential. This significant association requires further studies to avoid establishing a simplistic unidirectional and reductive linear cause-effect relationships. Indeed, a high verbal potential can elicit and/or reinforce anxiety-producing representations, but anxiety disorders may also lead to a defensive over investment of verbal language. The results are discussed in this article and suggest that scholastic and/or psychological difficulties encountered by some children with HIP can be related to their high intellectual potential. It is necessary to develop therapeutic and educational care adapted to these children from a better understanding, based on research results, of their possible difficulties but also cognitive abilities. Even when children with HIP have scholastic and/or psychological difficulties, some of their cognitive skills can be preserved contrary to appearances, with for example, as seen in the CNAHP results, excellent attentional capacities shown by cognitive tests contrasting with behavioral attention deficit reported by parents. These skills are important to identify as they are resources which support the therapeutic and educational project. It is probably through an articulation among professionals from national education, health and research, in alliance with the family (parents, child, and siblings), that advances will be made. In the same way that professionals have been interested in children with intellectual disabilities, it is important to be concerned by children with HIP and difficulties located at the other end of the continuum. It is a question of ethics which concerns both caregivers and teachers. It is also a societal issue that concerns all of us given that the expression of high intellectual and creative potential in children may be essential to the societal development of innovative strategies and each nation's future. Finally, the discussion can be extended to all children, independent of their potential. What we learn from children with HIP and difficulties can be applied to each child: it is important at family, school and societal levels to facilitate the expression of the potential of children, to value their skills, and to help them to remove possible inhibitions of their potential based on individualized projects. The acceptance of singularity and differences in children can contribute to tolerance and the development of creativity, in the interest of the subject and of society.     

Mesure de la conscience du trouble chez 100 malades hospitalisés en psychiatrie

Insight and awareness of disorder are an important domain for research and practice in psychiatry. Several instruments to measure insight are currently used. We present here a short scale (eight items) easy and quick to use. In a sample of 100 psychiatric inpatients (DSM-III diagnosis) it shows that the degree of awareness is different according to the type of hospitalization (insight is significantly higher in free and volontary hospitalizations compared to compulsory hospitalizations), in mood disorders compared to schizophrenia, in married patients compared to single patients. Finally, insight is significantly better if cognitive functions are higher (MMSE score). Awareness must be taken into account in all major mental disorders. Therapeutic alliance, treatment compliance, prognosis and risk of relapes depend largely on this dimension.     

Nouvelles parentalités : l’enjeu de la parentalité psychique

We will put here the concept of psychic parenting to highlight the relevance of using it in the clinic of new parenthood. Indeed, the new ways of doing-family: homo-parenting, single parenthood and heteroparentality involve distinguishing biological infertility from social infertility. In the same way, the distinctions between biological parenthood, social parenting, psychic parenting are essential. On the occasion of the revision of the law of bioethics planned for 2018–2019 in France, we will thus try to nourish and enlighten the ethical debate essential to lead and at the heart of which we will place the child's interest.     

Processus de radicalisation en milieu carcéral : de la criminogenèse à la radicalogenèse

ObjectivesTo demonstrate the process of radicalisation within the prison environment, via the notion of radicalogenesis, by analogy with the concept of criminogenesis While the latter focuses on the pre-criminal situation and studies what prompts a subject to engage in criminal activity, for the genesis of radicalisation we concentrate on the post-criminal situation of individuals, in order to untangle the stages that can bring a prisoner to become radicalised.MethodAn analysis of the literature on the process of radicalisation, and on the genesis of criminality; this is backed up by the methodology of clinical follow-up in the context of the psychological/psychotherapeutic work undertaken with detainees over a period of six years in French prisons.ResultsThe results from the follow-up of detainees caught up in a process of radicalisation, and from the review of the literature show that the prison environment can facilitate radicalisation through a process whereby the identity of an individual becomes more vulnerable following a criminal act that leads to incarceration – an act that is sometimes traumatic for the perpetrator.DiscussionHaving summarised, in table form, the different theories of radicalisation, and discussed their points of similarity/difference, we describe four phases in the genesis of radicalisation: vulnerable identity, dis-identification, conversion and re-identification, radicalisation. We want to emphasise that this process is strictly individual and depends on the subjective structure of the person becoming radicalised.ConclusionsWe reiterate the importance of psychological/psychotherapeutic support in prisons, particularly for the more vulnerable individuals, and those made more vulnerable still by their acting-out. Without this support, the individual risks becoming radicalised in order to find a new pole of identification, as a means of survival.     

Re-institutionnalisation ou désinstitutionnalisation ? Regards croisés entre la France et l’Argentine : à propos des réglementations en santé mentale

Objective

While psychiatry has never been defined as guaranteeing the law, its purpose socially and historically has been defined as protecting society from its most intolerable by-products. We will see how the evolution in the treatment of insanity in France and its influence on Argentinian psychiatry has brought us today to very different and even opposite situations in the area of mental health policies in these two countries.