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A first Assessment and Orientation Center (CAdEO) was created in Lyon at the beginning of June 2020 in order to facilitate access to mental health care. This structure allows any person who requests it to access a psychiatric assessment within a few days. It does not implement a follow-up, but it allows the person to be quickly directed towards the structure or the professional, public or private, who will be able to provide the care he or she needs. The CAdEO relies on a multidisciplinary team, which includes psychiatrists, psychologists and nurses (including an advanced practice nurse), in order to provide a adjusted assessment and orientation. It opens from Monday to Friday. The CAdEO, which is located in the city center, works in close partnership with the general practitioners in its health territory, as well as with all the health, medico-social and social services involved in the field of mental health. Among its consultants, about 4 out of 5 people are referred to private practice or associations. One person out of five is referred to other services in the general psychiatric sector, of which the CAdEO is the entry point. [ABSTRACT FROM AUTHOR]

Dès la fin des années 90, certains secteurs psychiatriques ont développé une démarche pro-active envers un public particulier : personnes en grande précarité et exclusion ET présentant une souffrance psychique nécessitant des soins spécialisés en psychiatrie. Cesdispositifs préfiguraient ce que deviendront plus tard les Équipes Mobiles Psychiatrie Précarité (EMPP). Faire accéder ce public aux soins et aider à leur maintien dans les soins devenait le pivot de leur activité. Au fil des décennies ces actions se sont précisées et venues combler les difficultés du Secteur Psychiatrique quant à l'accès aux soins de ce public. Population: L'acronyme « SDF » ne suffit plus à caractériser le public vers lequel se tourne les EMPP. En effet, peine supplémentaire, ces personnes doivent être porteuses de trouble psychique. Depuis une petite décennie ce public évolue, auquel viennent maintenant s'adjoindre les personnes migrantes, dont la souffrance psychique est apparue dans leur pays d'origine et/ou lors du parcours d'exil, voire même depuis leur arrivée sur le territoire national. Missions: En premier, aller à la rencontre des « SDF », psychotiques ou pas, afin d'accompagner un parcours d'accès aux soins ou un retour aux soins psychiatriques. Parallèlement, auprès des acteurs de première ligne, il s'agit de faciliter les liens avec les structures sociales ou médico-sociales venant appuyer, compléter, soutenir le projet de soin. Toujours auprès de ces acteurs, la mission des EMPP est d'intervenir en appui et en soutien aux structures d'accueil et d'hébergement. Fonctionnement: Les EMPP sont des équipes pluridisciplinaires composées de psychiatres, infirmiers, assistants de service social, psychologues... Une fois la personne en souffrance psychique signalée à l'équipe par les acteurs de première ligne, une visite à domicile pour sans domicile s'organise au plus près du patient (en rue, centre d'hébergement, accueil de jour...). Cette démarche d'aller vers permet une première rencontre, puis d'autres, afin d'évaluer la situation médicale, psychiatrique et sociale de la personne concernée et de la faire accéder aux soins les plus adaptés à son état. Les actions des EMPP s'effectuent aussi auprès des acteurs de première ligne visent à sensibiliser, informer et former à la souffrance psychique, à la psychiatrie en précarité. Des analyses de pratique et autres échanges d'appui et de soutien viennent compléter ces actions aidantes. Travail en réseau: Le réseau avec lequel travaillent les EMPP est particulièrement étendu dans la mesure où il concerne tous les acteurs de la Cité, des Communes, des Communautés de Communes, du territoire couvert par l'EMPP concernée. De fait, cela implique les Conseils Locaux de Santé Mentale (CLSM), les réseaux solidarité, les membres des veilles sociales, les coordinations de maraudes, d'une façon générale tous les acteurs de première ligne, tous les accueillants des structures, et bien sûr tous les Secteurs de psychiatrie. Dans les petites communes les partenaires se rencontrent assez facilement, mais cela s'avère plus complexe lorsque les territoires sont très étendus ou dans les mégapôles où le nombre de partenaires varie au gré des mouvements des structures d'accueil et d'hébergement. Nombre, durée et lieux d'intervention: Les EMPP n'ont pas vocation à augmenter en permanence leur file active mais représentent parfois pour les plus démunis une première rencontre et doivent plutôt assurer une noria, avec un accès aux soins de relais dans les structures de droit commun et, une fois allégées de ces missions, aller à la rencontre d'autres personnes. Chaque équivalent temps plein (ETP) de professionnel accompagne entre 50 et 80 personnes par an. L'activité est donc ETP dépendante. La durée est celle suffisante à l'accompagnement vers ces structures, parfois quelques heures, parfois quelques années... En principe les lieux d'intervention sont représentés par tout lieu de vie ne correspondant pas à un habitat personnel (rues, parcs, jardins, bois et forêts, squats, lieux d'accueils et d'hébergements, etc.). Tout lieu où le secteur de psychiatrie ne se déploie pas. Conclusion: Le maillon faible du Secteur psychiatrique est le soin aux plus démunis. Les EMPP tentent de combler ce manque. Les disparités géo-populationnelles entraînent une grande variabilité des acteurs et des actions. La force des EMPP réside dans leur souplesse, adaptabilité et proactivité. [ABSTRACT FROM AUTHOR]

The mobile teams, born in France in a spontaneous way about twenty years ago, are part of a sectoral history itself resulting from a move from the hospital to ambulatory devices. This offer, particularly in the consultation centers (CMP), will have been a success in view of the importance of the activity carried out and currently a limit in terms of capacity, requiring a modality of responses to the situations of people who, despite their need, do not go to these centers. The mobile teams by their availability to get ahead of these situations before they deteriorate and by their responses, limit the use of emergency services and hospitalization. The mobile teams, thanks to their responsiveness and creativity, make it possible to support complex outpatient follow-ups. They represent the tool that the sectoral mechanism lacked to reach its objective of outpatient work. The satisfaction to see their development throughout the territory, fruit of a real militant work, will be complete if the concept is not distorted as might be feared by the appearance of mobile teams which bear only the name or others so insufficiently equipped that they will not be able to achieve their objectives. In order for mobile teams to be recognized as equipment of the Sector, the specifications must be defined to guarantee the concept. [ABSTRACT FROM AUTHOR]

Since Snell (1852) many psychiatrists and psychoanalysts have questioned about psychotic neologisms. Classically they are subdivided into passive neologisms and active neologisms (Lefevre, Seglas), following in this a process "automatic " or a "voluntary " process. The word invented, according to Seglas, "says all", in other words, says all of the delirious thought of the subject, as if it were condensed the elements, imposing itself therefore as an evidence. So the neologism would have a sufficient "weight" that would allow the subject to be content with it and to have nothing more to explain. Beyond this singularity of language, beyond the mere semiological aspect and its interest in differential diagnosis, we will see that neologism imposes itself as a necessity. This means that it cannot simply be a "sign" for the clinician, and that it cannot wear the "clothing" of the deficit. On the contrary, this creation, this invention, must have a function for the subject. These are words or expressions that go beyond the common language, that separate from the "mother tongue", that must be distinguished from the spirit word, and that highlight the singular relationship of the subject to his "Other", which have in some cases (schizophrenia) a function of regulation in relation to the "Other", to the enjoyment, and to the very thought of the delusional, whose reality, the relation to the world, could without this support drift away. [ABSTRACT FROM AUTHOR]

Contemporary psychiatric phenomenology has been able to link disturbances of the minimal self to schizophrenic disorders. Indeed the impairment of this component of the Self, seen as a prerequisite to the capacity to participate actively in our experiences and to recognise them as our own, would explain the particularities described by schizophrenic patients. If analysis of this must be guided by a dual interpretation, allowing for the alternation of hyperreflexivity and intercoporeality disorders, then the EASE is the preferred descriptive scale for objective investigation of minimal self disturbances. By allowing for a co-construction of a language to describe the individual's experience, the EASE enables the irregularities of the Minimal Self to be taken into account, thus fulfilling both a diagnostic and a prognostic function, as we can observe. Two explanatory models regarding the presumed origin of these disturbances prevail, respectively attributing these changes to meta-cognitive defects and impaired processes which take place before the action – implying the emission of an efference copy. Minimal Self disturbance remains difficult to grasp, nevertheless we wish to offer an analysis through the lens of two works of popular culture. In Cyberpunk 2077, the protagonist experiences the insertion of another personality in his (or her) psyche with which he(or she) must cohabit and work towards a common aim, thus presenting a disturbance in the lived-in body. In Fight Club, Tyler Durden experiences the parasitic sensation of being taken over by a foreign body, situating its effect to the point of annihilation by shooting himself in the skull, and that we may explore through the perspective of the delusion of a takeover of the mind. [ABSTRACT FROM AUTHOR]

Psychiatrist Daniel Zagury discusses his journey, his joys, his disappointments, his questions in this interview for Perspectives Psy. This meeting is the opportunity to come back more extensively to the perspective that this great clinician has on psychiatry, its development and on his passion for this discipline. [ABSTRACT FROM AUTHOR]

A few thoughts inspired by this paradoxical period as we wander through the world of lockdown: Could not multiple barriers rise up while others are demolished in order to give life every chance? [ABSTRACT FROM AUTHOR]

Scientific advances now offer the possibility of changing sex. Gender-related suffering is now recognized as gender dysphoria and recent studies show the value of early and multidisciplinary care for adolescents suffering from gender dysphoria, underlining the importance of the necessary listening skills to be provided by psychiatrists. In this article, we have taken up the latest international recommendations of the World Professional Association for Transgender Health (WPATH) standards of care from 2011 to guide our reflections on the questions asked by the young people we welcome in consultation about the feeling of not being of the right sex. The aim of the study will be to bring into resonance and question our positioning, particularly in terms of identity and identification, as a caregiver working in a non-specialised consultation framework for gender dysphoria with those of young people and their families in these particular cases. [ABSTRACT FROM AUTHOR]

Training of psychiatrists must take into account the important development of knowledge and the evolution of society along the XXIst century that will lead to personalized medicine, the diversification of its activities and finally huge changes in practices. The third cycle reform of medical studies can be a chance to reach this goal. Psychiatry remains a united discipline with a single diploma, but new specialized training such as old age psychiatry or transdisciplinary training are emerging, some remained to develop forensic psychiatry. The postgraduate reform leads to a course of practical and theoretical training in three distinct phases organizing a progression of knowledge to acquire mainly at the beginning and skills gradually increasing towards a progressive autonomy. The improvement of training in research and psychotherapy is a priority that can be limited by an insufficient number of academic practitioners in psychiatry. [ABSTRACT FROM AUTHOR]

Over the past 50 years, Belgian psychiatry has moved in parallel with other countries towards a gradual differentiation of training courses in psychiatry and child and adolescent psychiatry. Although specific courses have coexisted for over 30 years, in 2003 a Royal Decree introduced specific training methods. Pillars of competencies for psychiatry and child and adolescent psychiatry exist and must be taught. The specificity of each specialty must be respected in order to develop a health care system that best meets public health needs as well as new mental health policies. [ABSTRACT FROM AUTHOR]

Autism Spectrum Disorder (ASD) affects 1% of the general population, mostly boys, and has a complex etiology. Recent advances in molecular genetics now make it possible in 25 to 30% of cases to diagnose a rare disease. From standard diagnosis (in particular by molecular karyotype) to research (Next Generation Sequencing), we present in the first part of this article a practical synthesis of the links between genetics and psychiatry in the context of ASD. In the second part of the article, certain mechanisms are discussed to explain how such diverse genetic diseases, involving different chromosomes and genes, can lead to a common clinical phenotype of ASD. From this discussion, we conclude with a proposal to change perspectives on ASD by using a multidimensional, dynamic and developmental approach, but also a transnosographic one allowing to follow and compare the evolutive trajectories of the considered dimensions. [ABSTRACT FROM AUTHOR]

Introduction in France of psychiatric phenomenology from the beginning to the half of 20th century is strongly linked to Eugene Minkowski. Indeed, despite the political context in Europe (first and second world war), Minkowski managed to pass psychopathological works between German (and in particular phenomenological psychiatry) and French psychiatry. This paper comes back the role of Minkowski in the introduction of phenomenological psychiatry in France. [ABSTRACT FROM AUTHOR]

In the world of massively multiplayer online role-playing games (MMORPGs) a program ceaselessly in evolution makes the reality interacting with myths. The player evolves in a universe of performance and profit. The characters are defined by a palette of calculated and available strengths according to devices. This excessive technicization is the reflection of the evolution of the society where the depth dimension of the human experience is considerably reduced. Addiction springs from the breach offered by the illusion of omnipotence brought by the identification to an idealized character. Prevention attitudes foster the self- reflection on what the game allows to discover on one's own functioning and help alleviating the avoidance of the intrinsically problematic human relationships. [ABSTRACT FROM AUTHOR]

From a historical perspective, this article explores the genesis of the rapprochement between madness and creativity in psychiatry. The corpus includes the works of two alienists, still too often neglected in historical debates in psychiatry and yet regarded as pioneers with respect to their studies and research on intellectual overactivity amongst lunatics: Maximien Parchappe de Vinay (1800-1866) et Henri Sentoux (1835-1880). [ABSTRACT FROM AUTHOR]

The response following the administration of a substance by definition pharmacologically inactive constitutes the placebo effect. Intrication of various mechanisms makes it impossible to analyze them separately and complicates the study of the placebo effect. This is a global therapeutic context, related to the activation of general and specific neurofunctional circuitry. The placebo effect is based on expectation and conditioning mechanisms under the influence of dopamine and opioid system as documented by neuroimaging studies. Cerebral structures such as the amygdala, the hippocampus and the nucleus accumbens allow for the selection of relevant and rewardful information. Memorizing the response will lead to the reactivation of the same circuitry at the next medication time. The placebo drug thus has an indirect neurobiochemical action, which explains its effect. Using a placebo in clinical research may seem unavoidable at first sight, as it ensures scientific validity to studies. But in medical research, this use is controversial, because of the obvious ethical questions it raises. Recognized by Evidence Based Medicine, placebo becomes essential to research after the Second World War. Later, the Helsinki declaration of 1964 will organize then restrict this placebo use, in order to safeguard the patients' rights. It is the pursuit of a compromise between the code of ethics and the use of placebo, by using double placebo, informed consent and the person's consent committee's supervision, that will ensure scientific validity to studies. Then, ethically acceptable as scientifically valid, these trials will be useful for the patients. [ABSTRACT FROM AUTHOR]

In keeping with the Helsinki statement in 2002, bioethics regulation imposes the physician to provide his patient clear and loyal information on treatment. This obligation, in association with the rise of psychopharmacology, has contributed to reducing the use of placebo in clinical practice, confining its use to clinical trials. The effectiveness of placebo in the treatment of depression is around 50 %. In severe forms, it is 30 to 40 % and exceeds 70 % in milder forms. Placebo treatment does not increase the risk for suicide. The patient's positive expectations, the fair compliance, the prescriber's beliefs and the quality of the doctor-patient relationship contribute to its efficacy. There is no documented personality traits of the responders. The placebo effect is maintained after disclosure of the nature of the treatment. Its effectiveness is enhanced when the explanations are clear and thorough. Given these findings, some authors question whether it is ethical not to prescribe a placebo in situations where the benefit/risk balance is in favor of this treatment. [ABSTRACT FROM AUTHOR]

La France est un des plus grands consommateurs de psychotropes dans le monde. Le volume de prescription de ce type de médicaments, par ses effets, représente un enjeu de Santé Publique. Il semble donc important de pouvoir s'interroger sur la place du placebo et notamment de l'effet placebo dans la prescription en psychiatrie afin de modifier notre approche du médicament et d'optimiser son efficacité. Après une approche historique de l'origine du placebo et sa place dans le système français, nous détaillerons les facteurs influençant l'effet placebo et les différents mécanismes mis en jeu. Ceux-ci ont été décrits dans de nombreuses études. Plus récemment, grâce aux nouvelles techniques d'imagerie (PET scan, IRM fonctionnelle), ces résultats parfois empiriques ont pu être démontrés scientifiquement avec un retentissement pas uniquement subjectif sur la qualité de vie du patient mais modulant le fonctionnement cérébral et le métabolisme de celui-ci. Ces études montrent l'importance du contexte lors de la prescription et de la dimension interactionnelle permettant ainsi la mise en place d'une alliance thérapeutique améliorant l'efficacité du médicament. Cela ouvre de nouvelles perspectives : de nouvelles études ne permettant pas uniquement de constater, mais surtout de comprendre le fonctionnement de l'effet placebo afin d'optimiser la prescription et de limiter l'escalade thérapeutique. [ABSTRACT FROM AUTHOR]

The author reviews the history of the French psychoanalytic movement called -psychotherapie institutionnelle- and highlights its relevance for the current psychiatric practice. [ABSTRACT FROM AUTHOR]

The Russian psychoanalysis, precociously born in the early XXth century thanks to the Russian intelligentsia's conjuring for all what came from the « Enlightened Occident », near the 1930 vanished because of the triumph of Marxism. The sociologizing ideology excluded any depth psychology. This was only with the end of the utopical power in August 1991, that the Russian psychoanalysis difficultly began to reborn, bothered by the wild psychoanalysis exploiting the market of psychic sufferings. This movement looked for its own way among the different trends in world psychoanalysis, competing for new psychoanalytical filiations established in the new Russia. [ABSTRACT FROM AUTHOR]