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Along with colour, form and texture, the line is one of the constituents of the visual sign. Perhaps the most important considering the amount and diversity of the signifieds that it is able to carry. This is all the more surprising if we know that there are no lines in the Lifeworld: these being pure constructions of our information-processing system. The semiotics of the line is thus deeply rooted in perceptive mechanisms. The constraints thus generated are constituing five distinct degrees zero, each of which can be deliberately violated by rhetorical operations, of which selected examples are shown. We will then identify four types of lines: contour or outline - hollow line - virtual line - locus-line. Additional reflections are finally devoted to the straight line, to the line dimensionality and to the line meaning [ABSTRACT FROM AUTHOR]

Résumé: Les aliments industriels destinés aux nourrissons (4–12 mois) et enfants en bas âge (1–3ans) (en dehors des laits infantiles et des céréales), dénommés aussi aliments pour bébés, se distinguent des aliments industriels non spécifiques conçus pour les adultes et des aliments courants par des critères stricts de composition et de sécurité sanitaire définis par la réglementation française et européenne. Évaluée en France à 89 666 tonnes en 2011 l’offre commerciale pour ces denrées vise à répondre à tous les besoins alimentaires des jeunes enfants : produits laitiers, denrées salées et sucrées, adaptés à l’âge (composition, texture, portions). Les aliments pour bébés ne représentent qu’une part modérée des apports alimentaires des 4–36 mois. Exprimés en pourcentage de l’apport énergétique total, ils constituent en moyenne 7 % de la consommation à 4–5 mois, 28 % à 6–7 mois, 27 % à 8–11 mois, 17 % à 12–17 mois, 11 % à 18–24 mois. Vingt-quatre pour cent des parents n’en donnent jamais à leur enfant, 13 % 1 à 3j/semaine et 63 % 4 à 7j/semaine. Même chez les gros consommateurs, les aliments pour bébés ont peu d’effets sur la qualité nutritionnelle du régime. Cependant, leur emploi retarde et diminue l’utilisation des aliments industriels non spécifiques, ce qui peut contribuer à réduire les risques nutritionnels et toxicologiques liés à la consommation de ces denrées chez les jeunes enfants. Si ces produits sont bien adaptés aux nourrissons et enfants en bas âge, ils doivent rester des aliments de sevrage et de complément à l’alimentation familiale ű faite maison Ƈ. [ABSTRACT FROM AUTHOR]

Abstract: Ferenczi produced elaborations on the regression, the traumatism, the transference and counter transference which question deeply the practice of the cure. His first texts (1908–1912) ask still current clinical questions (on the status of the interpretation and on the place of the body and of the acting in the cures, on the status of the language) and open the way to the elaborations of other psychoanalysts. They will be used as a point of departure of our reflection. [Copyright &y& Elsevier]

Abstract: Introduction: Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations in the GLA gene, which leads to a deficient activity of α-galactosidase A. α-galactosidase A activity can be assayed on dried blood spots on filter paper but the original method has been associated with a number of false positive due in great part to quenching of fluorescence. Here, we describe an adaptation of the original fluorimetric method reducing quenching of the fluorescence. Results: A simple and sensitive fluorimetric method has been described for the determination of the α-galactosidase A activity in dried blood spots on filter paper, convenient for screening of FD in at-risk populations. The procedure uses 4-methylumbelliferyl-α-D-galactose, as a synthetic substrate for the enzyme. In this study, protein precipitation was added after incubation both to stop the enzymatic reaction and eliminate interfering proteins. With the novel method the risk of false-positive due to fluorescence quenching was minimized. A cut-off level of 2.1 μmol.h–1.L–1 (control values: 5.6 ± 2.0 μmol.h–1.L–1, mean ± SD) was chosen corresponding to 40 % of median control value. In all 60 hemizygotes males, α-gal A activities were below 1.1 μmol.h–1.L–1 (0.11 ± 0.2 μmol.h–1.L–1). In the 68 heterozygous females, α-gal A activity ranged from 0 to 7.8 μmol.h–1.L–1 (2.2 ± 1.7 μmol.h–1.L–1). Using the improved methodology, one third of the females were not identified using the enzymatic assay, due to significant residual enzyme activity. Conclusion: This improved method for the assay of α-gal A was robust and reduced the number of false-positive results. It can be applied for the screening of at-risk populations. α-galactosidase A enzymatic assay should not be used for screening for FD in women or, if used, should be interpreted cautiously together with the results of genotyping. [Copyright &y& Elsevier]

This paper initiates a theoretical-clinical reflection on the specificity of child psychiatric support for children of psychotic parents or those suffering from severe personality disorders, at the time of the psychotherapeutic follow-up of a five-year-old child presenting psychomotor agitation. Over and above the multiple biopsychosocial risk factors, these complex situations require child psychiatrists to clarify their support and public health role in order to guarantee coherent care and expertise. Indeed, the various players involved (child welfare, justice, education, adult psychiatry, neuropediatric, etc.) may ignore one another or take on a role that exceeds their field of competence : the result is sometimes a certain confusion of roles, or even confusing measures and contradictory positions. When a child's symptomatology and that of his or her family preclude the use of classic, standardized interviews, it seems to us that narrative work is best carried out as close as possible to the subject's spontaneous enunciation (spoken or acted). We can then attempt to identify the operative stages of care and postulate that it is only when the child names his own impulsivity (his "crazy" part) that he will be able to recognize it in his parent. This opens the possibility of a certain representation of parental psychopathology and of putting it into narrative form. First postulated as a subject, this child is invited to name his psychomotor excitement, then that of his parent: "volcano". The loss of a concrete object, a "blue pebble", between two sessions, opens the space for representation and graphic expression. This object of reality becomes an object of mediation between him and his therapist and is presented as the support for a signifier, "blue": in this way, a process of encryption and symbolization begins, an attempt to put the world in order. The signifier "blue" (which cools and extinguishes fire) is articulated with the signifier "red" (which burns and excites) in complex constructions, but not without effect on the patient's body and symptoms. These clinical elements could be passed on to the various partners and could support their care, educational, rehabilitative and expert missions. [ABSTRACT FROM AUTHOR]

Résumé Objectif de l'étude L'objectif de ce travail était d'écrire le contrôle local, la survie globale, la survie sans progression et la toxicité de la radiothérapie en conditions stéréotaxiques par CyberKnife® pour les carcinomes hépatocellulaires. Matériels et méthodes Il s'agit d'une étude observationnelle rétrospective et multicentrique, menée au centre Eugène-Marquis à Rennes et au centre hospitalier universitaire Bretonneau à Tours, entre novembre 2010 et décembre 2016. Le traitement a été réalisé en situation de sauvetage, en d'attente d'une transplantation hépatique ou en dernier recours. Résultats Cent trente-six patients ont été consécutivement inclus dans l'étude. Le suivi médian était de 13 mois. La dose médiane totale prescrite était de 45 Gy en trois fractions sur 5 jours. Les taux de survie globale, de survie sans progression et de contrôle local à 1 an et 2 ans étaient respectivement de 79,8 % et 63,5 % ; de 61,3 % et 39,4 % ; de 94,5 % et 91 %. Deux évènements de toxicité aiguë de grade 3 et deux de toxicité tardive de grade 4 ont été rapportés. Sept patients ont souffert d'une hépatite radio-induite classique et 13 d'une hépatite radio-induite non classique. Le stade selon les critères diagnostiques de Barcelone (Barcelona Clinic Liver Cancer [BCLC]), l'indice de performance selon l'Organisation mondiale de la santé et le volume cible prévisionnel étaient corrélés avec la survie globale en analyse de Cox unifactorielle. Conclusion La radiothérapie en conditions stéréotaxiques est un traitement efficace et bien toléré pour les carcinomes hépatocellulaires inopérables ou en attente de transplantation. La toxicité est principalement liée au terrain cirrhotique et implique une sélection des patients et des contraintes de doses strictes sur les organes à risque. Abstract Purpose The purpose of this paper was to describe local control, overall survival, progression-free survival and toxicity of CyberKnife®-based stereotactic body radiation therapy of hepatocellular carcinoma. Material and methods Records of all the patients treated for hepatocellular carcinoma at the Eugene-Marquis cancer centre, Rennes and the Bretonneau hospital, Tours (France), between November 2010 and December 2016, were reviewed. Radiation therapy was performed as a salvage treatment, while awaiting liver transplantation or if no other treatment was possible. Results One hundred and thirty-six patients were consecutively included in the study. The median follow-up was 13 months. Median total dose prescribed, fractionation and overall treatment time were respectively 45 Gy, three fractions and 5 days. Overall survival, progression-free survival and local control rates at 1 year and 2 years were 79.8 % and 63.5 %, 61.3 % and 39.4 %; 94.5 % and 91 %. Two grade 3 acute toxicity events and two grade 4 late toxicity events corresponding to a duodenal ulcer have been reported. Seven patients underwent classic radiation-induced hepatitis and 13 patients showed non-classical radiation-induced hepatitis. Barcelona Clinic Liver Cancer stage, World Health Organisation grade and planning target volume were correlated with overall survival in univariate Cox analysis. Conclusion Stereotactic body radiation therapy is effective and well-tolerated for inoperable hepatocellular carcinoma or as a bridge to liver transplantation. Toxicity is mainly related to cirrhotic background and requires a selection of patients and strict dose constraints. [ABSTRACT FROM AUTHOR]

We propose in this paper a reflection about the relevance and the particularities of the use of therapeutic mediations in the context of clinical practice in consultation-liaison child psychiatry. The accompaniment of a young teenager leading to the creation of a multimedia clip is presented to illustrate the use of therapeutic mediations. This case is then the object of a theoretical and clinical analysis in order to highlight and analyze the psychic processes associated with the use of this mediation. The therapeutic mediation has favored the expression of the patient's desires and anxieties according to a multisensorial dimension – words, melodies, pictures – which supports and catalyzes the primary and secondary symbolization processes. The approach based on therapeutic mediations emphasizes the implementation of a "tailor-made" accompaniment which results in the co-construction of the mediation with the patients. The use of therapeutic mediations in the context of the consultation-liaison child psychiatry appears to be a relevant tool that favors the clinical encounter and the deployment of symbolization processes. [ABSTRACT FROM AUTHOR]

Résumé L’article propose de soulever certaines questions cliniques et épistémologiques posées par la notion de vulnérabilité psychotique, dans le champ de la psychopathologie de l’enfant et de l’adolescent. La vulnérabilité s’est en effet constituée comme un paradigme majeur de la santé mentale contemporaine, suscitant un nombre considérable de recherches sur les facteurs de risque et d’apparition des troubles psychotiques. Les études consacrées au risque de psychose et à sa détection précoce ont marqué, depuis une vingtaine d’années, un tournant dans les modèles de vulnérabilité : les facteurs de vulnérabilité y sont englobés dans la catégorie dite à très haut risque ( ultra-high risk ), voire dans un syndrome de risque de psychose. Mais, concevoir la vulnérabilité comme risque pose plusieurs problèmes : celui d’une spécificité clinique suffisante pour fonder la prédiction, et celui de sa fidélité aux trajectoires développementales singulières. L’article examine ces interrogations à partir de deux exemples aujourd’hui paradigmatiques de la vulnérabilité psychotique : celui des expériences dites quasi-psychotiques chez l’adolescent, et celui du syndrome développemental de microdélétion 22q11.2. Background The goal of this paper is to shed light on specific clinical and epistemological questions raised by the notion of psychotic vulnerability in the field of child and adolescent psychiatry. This notion has nowadays become a major research paradigm and orients numerous studies on risk factors for transition to psychosis. In the last 20 years studies focusing on such risk factors and their early identification have given a new impetus to models of vulnerability: they unify vulnerability factors under the category of ultra-high risk, or even risk syndrome for psychosis. Method A review of the conceptual and historical background framing the notion of vulnerability sheds light on epistemological and clinical ambiguities characterizing its scope and relevance for child and adolescent psychopathology. The paper aims to clarify these questions raised by the vulnerability models by focusing on two paradigm cases of vulnerability to psychosis: psychotic-like experiences in adolescents, and the 22q11.2 microdeletion developmental syndrome. Results The discrepancy between the statistical background of vulnerability factors and a clinical understanding of the vulnerability involves two main difficulties for the clinical scope of these models: the first one relates to a specific vulnerability to psychosis, opposed to a general vulnerability to develop a mental disorder. The second one is the difficulty to grasp, from the perspective of risk models, the clinical and dynamic temporality of the transition toward psychotic symptoms. Discussion These ambiguities raised by the ultra-high risk models call for a psycho-dynamic approach, regarding diagnosis in light of a subjective experience and trajectory, and of the psychic functions and dynamics of a symptom. Such a psycho-dynamic point of view can shed light on a clinical understanding of the vulnerability models. [ABSTRACT FROM AUTHOR]

Résumé Objectif Cet article se donne pour but d’illustrer la spécificité de la valence anale dans le délire paranoïaque (délire de persécution). Il s’agit par-là de discerner la valeur des apports de Karl Abraham sur un critère permettant le diagnostic différentiel entre la paranoïa et la schizophrénie. Méthode Une étude des textes de Freud et de ses premiers continuateurs permet de souligner combien ils ont accordé d’importance à la valence anale dans la paranoïa. Les auteurs s’appuient sur un cas clinique ayant valeur d’exemplarité pour mieux saisir la portée, la place et le rôle de la dimension anale dans le fonctionnement psychique du sujet. L’importance d’une idée de « viol homosexuel » pour le patient dont il est question est mise en exergue. Ses protocoles Rorschach sont étudiés afin de déceler la manière dont la valence anale s’y traduit. Résultats Nous mettons en évidence la fixation anale comme un indicateur primordial dans la paranoïa. Ce critère permet de distinguer la paranoïa de la psychose maniaco-dépressive (bipolarité) et de la schizophrénie. Discussion Cet article ouvre sur la recherche de critères différentiels entre paranoïa et schizophrénie. Il montre aussi combien il importe d’établir une nette distinction entre l’homoérotisme pré-œdipien qui transparaît dans la paranoïa et l’homosexualité proprement dite (œdipienne, génitale). Conclusion La valence anale est un critère pertinent pour distinguer la paranoïa de la schizophrénie, mais aussi de la psychose maniaco-dépressive (bipolarité). Elle peut être mise en évidence notamment grâce à l’analyse de protocoles Rorschach. Objective The very existence of paranoid delusions as distinct from schizophrenic disorders has been widely discussed in recent years. Taking into account these controversies, this paper presents the distinctive features of the anal dimension in paranoid delusion (persecution delusion). The authors aim to show the value of Karl Abraham's theoretical contribution in the form of a criterion which, he claimed, enabled a differential diagnose between paranoia and schizophrenia. The study of Abraham's texts also reveals a criterion enabling a differentiation between manic-depressive psychosis (bipolarity) and paranoia. This paper sets out to test the validity of Abraham's hypothesis by analysing Rorschach protocols of his psychotic patients. Methodology A close reading of several theoretical texts written by Freud and his first followers shows how important they considered the anal dimension in paranoia to be. In what is still considered as his most important text on paranoid psychosis, the Schreber case , Freud shows that the theme of a passive position in sexual intercourse (equivalent to anal penetration) was central to Schreber's view of delusion. Besides Karl Abraham, three of Freud's first supporters, namely Eduard Hitschmann, Johan van Ophuijsen and August Stärke, proposed a detailed description of the anal dimension in some of their paranoid patients. They suggested that, in persecution delusion, an equivalence exists between the paranoid subject's persecutor and the anal object. The authors focus on an exemplary clinical case so as to better understand the scope, the place and the function of anal factors within a paranoid person's psychical functioning. For the patient described, the importance of the idea of a “homosexual rape” is underlined. The subject's whole delusion revolves around it. It is central to his delusional ideas, where the anal dimensions are further illustrated by the results of projective tests. The Rorschach protocols are closely examined so as to discover how they reflect the anal dimension within this paranoid patient's mind. We also note the need to avoid confusion between the purportedly homosexual ideas of psychotic patients (which, in fact, mostly boil down to homoeroticism ) and homosexual orientation properly speaking (which cannot be considered as a disorder). While psychotic homoeroticism stems from a fixation at the anal, pre-œdipal stage, homosexuality constitutes a post-œdipal, genital sexual orientation in its own right. Whereas homosexuality is directed towards an external, self-sufficient object, homoeroticism is directed towards a narcissistic image that remains halfway between the subject and the other. The anal dimension of homoeroticism mostly shows in paranoid patients; it is not an attribute of homosexuality proper. Results The results show that anal fixation is a major indicator for paranoia. This criterion makes it possible to distinguish it from manic-depressive disorder (bipolarity) and from schizophrenia. In manic-depressive disorder, says Karl Abraham, the patient has fully introjected his love-object, whereas in paranoia, the love-object has been incompletely introjected, which creates a strong ambivalence that is reflected by the patient's behaviour. In contrast, in schizophrenia, the love-object has not been constituted as distinct from the patient; the patient remains at a pre-ambivalent stage. Whereas the paranoid patient tries to get rid of the (incompletely introjected) object, the schizophrenic patient feels under threat of being devoured by the love-object. In paranoid patient's Rorschach protocols, the ambivalence towards the object and its anal dimension shows through references to “dirty” animals or objects (“a petrol pit”, “a hog”, “a rat”). These patients harp on the “backside” or the “bottom” of the body. Finally, the male sex is described as aggressive, dangerous, and likened to “a knife”. In schizophrenia, in contrast, Rorschach protocols reflect fears of being devoured, with the mention of “jaws”, “crocodiles” and other such items. Discussion This study encourages future quantitative research on the topic of differential indicators for paranoia and schizophrenia. It tends to prove that paranoid delusions cannot be fully assimilated to schizophrenic disorders. Karl Abraham's differential criteria, based on clinical evidence, could be usefully confronted to Rorschach protocols in greater depth. Conclusion The anal dimension constitutes a valid criterion making it possible to distinguish paranoid disorders from schizophrenia, and also from manic-depressive psychosis (bipolarity). This dimension can be clearly brought to light by analysing psychotic patient's Rorschach protocols. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Cet article présente l’hypothèse, issue du champ de la psychopathologie phénoménologique, de l’hyper-réflexivité schizophrénique, selon laquelle les patients schizophrènes sont pris dans l’expérimentation d’une conscience qui se retrouve contrainte d’interroger des phénomènes qui devraient aller intuitivement de soi. Méthodes La perspective en première personne est une démarche qualitative complétant la lecture, traditionnelle dans le champ de la psychiatrie, en troisième personne – qui consiste en l’attribution depuis une position externe de signes cliniques repérés indépendamment du ressenti exprimé par le patient. Cette perspective en première personne concentre son attention sur l’expérience subjective qu’exprime le sujet. Le discours de plusieurs patients schizophrènes a été recueilli dans le cadre d’un dispositif clinique en utilisant l’échelle EASE ( Examination of Anomalous Self-Experience ). Cette échelle permet l’exploration semi-structurée, d’orientation phénoménologique, d’une série de difficultés révélatrices d’anomalies de l’expérience subjective. Résultats En plus des phénomènes d’hyper-réflexivité, nos analyses mettent en évidence deux grandes caractéristiques de l’être-au-monde schizophrénique. D’abord une problématique du sens commun, qui pose la question de l’intersubjectivité. Ensuite l’existence d’un trouble de l’intercorporéité, les expériences d’hyper-réflexivité schizophrénique s’accompagnant d’une perte du « corps commun ». Discussion L’application d’une perspective en première personne dans la compréhension du vécu des patients schizophrènes, ainsi que l’intérêt porté au phénomène d’hyper-réflexivité, permettent de proposer une vision de la schizophrénie qui n’est plus réduite à une lecture déficitaire de celle-ci (sans nier cette dernière), et qui découvre non pas un affaiblissement, mais une intensification de la conscience. Conclusions La prise en considération de la dimension tacite de l’existence schizophrénique, telle que le suggère la psychopathologie phénoménologique contemporaine, offre de précieuses informations à la pratique clinique et suggère d’importantes perspectives de recherche associant aux designs méthodologiques conventionnels des perspectives novatrices et prometteuses. Objectives This paper considers the hypothesis of schizophrenic hyper reflexivity, which originates in the field of phenomenological psychopathology. It discusses the methodological context enabling these highly subjective manifestations to emerge. Starting from the seminal hypothesis developed by contemporary psychopathology that schizophrenic patients experience a form of consciousness that finds itself forced to question phenomena that should be intuitively self-evident, the idea of the present paper is to complete the usual interpretation of schizophrenia as a deficit by the hypothesis of an excessive functioning of consciousness. Methods The first-person perspective is a qualitative approach completing the third-person interpretation, traditional in the field of psychiatry, which consists in the attribution, from an external position, of clinical signs noted independently from the perceptions expressed by the patient. The first-person perspective focuses on the patient's subjective experience as expressed by that individual. To understand schizophrenia according to this perspective, the narratives of several schizophrenic patients were collected in a clinical setting. We used the EASE scale ( Examination of Anomalous Self-Experience ) for this purpose. This scale offers a phenomenologically-oriented semi-structured exploration of a set of difficulties revealing anomalies in subjective experience, considered as self-awareness disturbances. EASE was developed on the basis of self-descriptions by patients suffering from schizophrenic spectrum disorders. This tool enables the co-construction of a language between patient and clinician, focused on the patient's particular experiences and the unique phenomena he has to cope with. Results Alongside the hyper reflexivity phenomena, the qualitative analyses of the descriptions collected highlight two important features of schizophrenic being-in-the-world. First a common sense issue, which raises the question of inter-subjectivity and the scope for schizophrenic patients to share in a social world. Secondly, the existence of an intercorporeality disturbance, since the schizophrenic hyper reflexivity experiences are accompanied by a loss of the “common body”, the body being the scene where inter-subjectivity is played out. Discussion The use of the EASE scale and the application of the first-person perspective provides a relevant psychotherapeutic approach, both in the process of acknowledgement of the illness (required from the patient as well as from the clinician), and in communication with the families of schizophrenic patients. Conclusions The phenomenological interpretation provided by the application of a first-person perspective in the understanding of schizophrenic patients’ experiences, and the inclusion of hyper reflexivity phenomenon, suggest perspectives on schizophrenia that are no longer reduced to a mere interpretation of deficit (without denying the deficit), showing not a weakening, but a surprising intensification of consciousness. [ABSTRACT FROM AUTHOR]

This paper attempts to illustrate the diagnostic, therapeutic and evolutionary aspects of a rare form of an acute neonatal arterial thrombosis. We report the case of a newborn female baby from a pregnancy complicated by gestational diabetes. At birth, we noticed a pallor of the left lower limb, coldness and absence of the distal pulses. Doppler ultrasound showed extensive thrombosis of the left femoral artery. Emergency treatment consisted of thrombolysis by tissue plasminogen activator, after eliminating contraindications. The evolution was rapidly spectacular with repermeabilization of the limb. Heparin was started as a relay treatment. The etiological assessment did not find any risk factor of arterial thrombosis. The dramatic outcome of arterial thrombosis of a limb is amputation. Early diagnosis and management can avoid this situation. [ABSTRACT FROM AUTHOR]

This paper attempts to illustrate the diagnostic and therapeutic approach of an extremely rare form of esophagogastritis with antenatal disclosure. We report the case of esophagogastritis with antenatal disclosure in a full-term newborn. E.K. was a newborn female baby from a pregnancy carried without complications. At birth, the amniotic fluid was hematic. Examination of the placenta at delivery was normal. The newborn presented hematemesis made of bright red blood, from the first hours of life, without any other associated signs or hemostasis disorder on the biological assessment. The initial therapeutic approach was exclusive parenteral nutrition combined with intravenous proton pump inhibitors. The evolution was marked by the occurrence of melenas and rectorrhagia, complicated by anemia requiring transfusion, without hemodynamic repercussions. An upper gastrointestinal endoscopy was performed on the third day of life and showed moderate erosive œsogastrobulbite. Follow-up was rapidly favorable. In severe neonatal digestive hemorrhages, FOGD plays a key role in the etiological diagnosis and therapeutic management. [ABSTRACT FROM AUTHOR]

Résumé Les méthodes d’évaluation du risque et des besoins des personnes contrevenantes ont grandement évolué au cours des 40 dernières années. Elles sont passées d’une évaluation impressionniste basée sur l’expérience clinique à une procédure systématique basée sur la recherche scientifique. Ce n’est toutefois que très récemment que les professionnels ont été en mesure d’avoir accès à un instrument spécifiquement conçu pour évaluer les facteurs de protection contre la récidive et la récidive violente. La Structured Assessment of Protective Factors for Violence Risk (SAPROF) est un outil utilisant le jugement professionnel structuré afin de documenter les éléments protecteurs chez les auteurs d’infractions. Elle comporte 17 domaines protecteurs répartis en trois grandes catégories de facteurs : les facteurs internes, les facteurs liés à la motivation et les facteurs externes. La SAPROF jouit d’un engouement important tant dans les milieux cliniques que chez les chercheurs et constitue un ajout utile au processus clinique d’évaluations des personnes. Risk assessment has greatly changed over the last 40 years. It has moved from a strictly clinical procedure based on clinical judgement, to a structured approach based on scientific literature. While the main goal of first generation structured methods was to estimate the probability of recidivism, we are increasingly interested in knowing more about the reasons that push delinquents to commit new crimes in order to properly intervene and treat the causes at hand. The last generations of instruments now aim to estimate intervention needs and guide rehabilitation practices. Although practitioners largely resort to protective factors to establish avenues to work on, no tool was available until recently to systematically evaluate protective factors. The present article proposes a description of the different measurement and conceptualization issues surrounding protective factors, in addition to addressing the nature of the effect of these factors on recidivism. This paper describes The Structured Assessment of Protective Factors for Violence Risk (SAPROF), a structural professional judgement tool that focus solely on protective factors for violence risk. The SAPROF investigates internal, motivation and external protective factors and has incremental validity over risk assessment instruments. The paper also discusses validation results of the SAPROF, as well as its limitations. The paper finally addresses the crucial question of interfacing risk and protective factors when it comes to estimating the risk for recidivism. [ABSTRACT FROM AUTHOR]

Résumé L’analyse interprétative phénoménologique permet au chercheur d’explorer l’expérience de participants, le sens qu’ils donnent à leur expérience et les mécanismes psychologiques sous-jacents. Elle est devenue une des approches les plus reconnues en psychologie et elle est utilisée de façon croissante dans d’autres disciplines. Étant donné cet intérêt croissant apporté à l’IPA, une introduction française est devenue nécessaire. Cet article débute par un rappel général des fondements conceptuels de l’IPA, suivi d’une revue point par point des étapes d’une recherche interprétative phénoménologique. Cet article traite des différents enjeux soulevés par cette approche et conclut avec plusieurs idées de développements à venir. Interpretative phenomenological analysis (IPA) allows researchers to explore the participants’ experiences, the meaning they gave to those experiences, and the underlying psychological processes. IPA recognizes this as involving a double hermeneutic where the participant is trying to make sense of what is happening to them and the researcher is then trying to make sense of the participant's sense making. IPA has now become one of the best known and most widely used qualitative approaches in psychology. After a first decade of development in the United Kingdom, IPA has become an integral part of the research landscape in health psychology and in clinical psychology, and is increasingly being used in other disciplines. It has helped to raise the awareness of a generation of researchers to what qualitative psychology can contribute, and it has enriched the repertoire of methodological practices available for addressing important issues in health. With the growing interest in IPA, we think it is now timely and valuable to offer a French introduction to this approach. The aim of this paper is to introduce to the French-speaking scientific community the foundations of IPA, the different steps involved in a research project and finally the avenues for developing the approach. This paper begins with a general overview of the theoretical foundations of IPA and its place in the scientific landscape in psychology. This is followed by a step-by-step guide to carrying out an IPA study. This begins with an outline of the structure and the content of the data collection process, and the conduct of the interview as well as the alternative frameworks to face-to-face interview and the recommended sample size. We have paid special attention to the analysis cycle and to the communication, assessment and scope of findings. To carry out good IPA requires grasping its core sensibilities. First, IPA has a commitment to an analysis which moves beyond the descriptive to the interpretative, but an interpretative grounded in the close reading of the participant's account. Second, IPA is strongly idiographic, beginning with the close analysis of each case and only then moving to a second level of analysis of the patterning of convergences and divergences within the corpus. Finally, the article discusses various issues arising from the approach and concludes with some thoughts on the issue of language and on future developments like the contribution of single cases, studies of dyadic and group dynamics and the continued involvement of IPA within mixed methods designs. [ABSTRACT FROM AUTHOR]

Résumé La radiothérapie en conditions stéréotaxiques des tumeurs hépatiques primitives et secondaires peut être réalisée en complément et/ou comme une alternative à la chirurgie et aux techniques de thermoablation. De nombreuses variantes techniques sont actuellement disponibles, ce qui entraîne une certaine hétérogénéité dans les modalités de délinéation, de prescription de la dose et de détermination des doses de tolérance aux organes à risque. L’objectif de cet article est de permettre une homogénéisation des pratiques afin d’améliorer la qualité et la sécurité de cette technique et de faciliter sa diffusion afin de répondre au principe d’égalité d’accès aux techniques innovantes pour le plus grand nombre de patients. Cette mise au point s’inscrit dans la continuité du guide Recorad, publié en 2016 par la Société française de radiothérapie oncologique (SFRO), en le complétant selon les données récentes de la littérature sur les tumeurs du foie. Stereotactic body radiation therapy for primary and metastatic hepatic malignancies can be performed in association and/or as an alternative to surgery and radiofrequency. The consequences of the great number of techniques available are heterogeneity in contouring, dose prescription and in determination of dose constraints for organs at risk. The objective of this paper is to improve the quality and safety and to help the diffusion of this technique for a majority of patients. In 2016, the French Society of Radiation Oncology (SFRO) published guidelines for external radiotherapy and brachytherapy (“Recorad”). This paper is an update of these recommendations considering recent publications. [ABSTRACT FROM AUTHOR]

Résumé L’article est consacré aux découvertes récentes des sites paléolithiques sur le territoire de l’oasis de Ferghana. Jusqu’à présent, dans cette partie de l’Ouzbékistan, les sites du Paléolithique supérieur restaient inconnus. Les gisements mentionnés dans l’article, préalablement attribués au Paléolithique supérieur, comble une lacune dans la Préhistoire de cette zone. Les industries du Paléolithique supérieur des sites de l’oasis de Tachkent (Kulbulak, Kyzylalma 2, Obirahmat) sont citées ici en tant qu’analogies des sites récemment retrouvés. The paper aims to present recent discoveries of Paleolithic sites in the Ferghana oasis. Until now, the Upper Paleolithic sites were unknown in this part of Uzbekistan. The archaeological deposits mentioned in this paper and preliminarily attributed to the Upper Paleolithic period fill a gap in the Prehistory of this zone. The Upper Paleolithic industries from the Tachkent oasis sites (Kulbulak, Kyzylalma 2, Obirahmat) are here presented as analogies ofrecently discovered sites. [ABSTRACT FROM AUTHOR]

Résumé Objectifs À travers un regard historique, on entend ici confronter le « credo néo-kraepelinien » qui donne à la psychiatrie actuelle, notamment américaine, sa caution épistémologique, au projet initial du père de la psychiatrie moderne. Méthode Pour ce faire, l’article propose de revenir sur le projet kraepelinien d’origine, l’évaluer en propre, le considérer pour lui-même et en sa complexité, en recourant à une analyse précise des grands textes du corpus kraepelinien. C’est autant les textes autobiographiques et méthodologiques que les différentes éditions du Traité qui sont ainsi analysés. Résultats Cette enquête dans les textes de Kraepelin nous invite à prendre en méfiance le soi-disant « empirisme » de la démarche kraepelinienne, et jeter corrélativement un soupçon sur le positionnement « a-théorique » ayant inspiré les tenants du DSM. Loin d’homologuer naïvement l’idée selon laquelle Kraepelin aurait patiemment collectionné les données étiologiques, anatomopathologiques et symptomatologiques de ses cas pour forger innocemment ses entités nosographiques, l’article conduit à réévaluer, dans le fonctionnement de la nosographie kraepelinienne, le poids d’un critère prépondérant, celui de la trajectoire que la pathologie dessine naturellement jusqu’à son état terminal, et qui permet de la déchiffrer sur le seul critère de son évolution. C’est en outre les rapports entre ce critère évolutif et le modèle naturaliste qui sont alors problématisés. Discussion Ressort de cet examen l’idée que l’œuvre du père de la psychiatrie moderne est plus complexe qu’il n’y paraît, et qu’il convient de se déprendre de « l’habillage méthodologique » d’allure empirique dont Kraepelin a enveloppé la construction de sa nosographie. En réalité, entre le projet officiel de Kraepelin et ses réalisations effectives, il y a un hiatus inexplicable : l’ambition méthodologique défendue par Kraepelin et les procédures empiriques qu’il défend n’expliquent pas le mécanisme de composition des entités concrètes qu’il a promues. Conclusions Cela permet de juger l’extraordinaire complexité de l’héritage kraepelinien et de comprendre cette postérité contradictoire, qui fait qu’aujourd’hui, la psychiatrie « néo-kraepelinienne » (se) reconnaît volontiers (dans) le projet kraepelinien mais morcelle les entités découvertes par Kraepelin, lesquelles se trouvent par ailleurs spontanément recaptées par des épistémè fondamentalement concurrentes, mais plus ou moins déconnectées du cadre nosologique naturaliste à travers lequel il les pensait et les identifiait à l’origine. Dans un cas, morcellement des catégories kraepeliniennes et encensement du projet kraepelinien ; dans l’autre, refus de la pensée kraepelinienne, mais fidélité à ses entités. Objectives Adopting a historical perspective, this paper sets out to compare the original project of Emil Kraepelin, the father of modern psychiatry, with the so-called “neo-Kraepelinian credo” which provides contemporary psychiatry, and American psychiatry in particular, with its epistemological framework. Method In order to achieve this objective, the article proposes to re-examine the original Kraepelinian project, to appraise it as such, and to explore its full complexity via an in-depth analysis of the main texts in the Kraepelinian corpus. With this aim in mind, both the autobiographical and the methodological texts, and the successive editions of the Textbook, are analyzed. Results This exploration of the Kraepelinian texts suggests that we should be wary of the supposed “empiricism” of the Kraepelinian approach, and also of the “a-theoretical” positioning of the proponents of the DSM. Far from naively supporting the idea that Kraepelin patiently accumulated etiological, anatomical and symptom-related data from his patients in order to straightforwardly construct his nosography, this article proposes to reassess the weight of a dominant criterion in this nosography – that of a pathological trajectory from the incipient stages to the outcome, enabling the pathology to be interpreted on the sole basis of its evolution. The complex relationships between this evolution criterion and the overall naturalistic Kraepelinian model of mental illness are thus explored. Discussion This exploration shows that the work of the father of modern psychiatry is far more complex than it might seem at first glance. We need to free ourselves from the seemingly empirical methodological trappings of Kraepelin's nosological classification. There is in fact a curious hiatus between Kraepelin's official project and what he actually produced. The methodological approach and the empirical procedures propounded by Kraepelin do not explain the mechanisms enabling the construction of the concrete entities that he supported. Conclusions Thus, the paper enables us to grasp the complexity of the Kraepelinian legacy more fully, and to understand the paradoxical nature of his posterity, whereby contemporary psychiatry readily claims to be “neo-Kraepelinian” but at the same time fragments these Kraepelinian entities. Alongside, these same entities are spontaneously taken up by clearly rival epistemologies that are more or less disconnected from the naturalistic nosological framework that underpinned them. On the one hand, there is a fragmentation of the Kraepelinian categories alongside the exaltation of Kraepelin's project; on the other hand, there is a rejection of Kraepelinian thought alongside faith in his categories. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Le cerveau et l’esprit sont très souvent objet de controverses dans les psychiatries du monde. L’histoire de la psychiatrie américaine est instructive à ce sujet, les États-Unis ayant accueilli très tôt la psychanalyse, inventé le béhaviorisme, promu la psychiatrie biologique, utilisé la biométrie et fabriqué la classification des maladies mentales qui a eu le plus grand succès. L’objectif de cet article est d’étudier cette histoire. Méthodes L’article propose une étude détaillée des théories, des pratiques et des débats d’idées dans le champ de cette psychiatrie américaine depuis le XVIII e siècle et des politiques fédérales de santé mentale. Résultats La psychiatrie des États-Unis a des particularités liées au concept de destinée manifeste, au protestantisme et au pragmatisme, à la manière dont la nation s’est construite (esclavagisme, conquête de l’Ouest, libéralisme économique) et aux guerres qui n’ont pas cessé de sa naissance à ce jour, de la guerre d’indépendance aux guerres du Moyen-Orient, en passant par la guerre civile et les deux guerres mondiales. Comme elle a su assimiler ses immigrés, elle a assimilé et véhiculé leurs cultures et leurs découvertes en matière de psychiatrie. Elle a elle-même donné naissance à de nombreuses théories et pratiques portées par la mondialisation, entre autres les DSM qui s’inscrivent dans l’évolution culturelle, scientifique, économique et politique de la nation. Les profanes ont été très tôt acteurs des changements, des conflits et de l’antipsychiatrie. Discussion Cet article s’interroge sur le succès croissant de la psychanalyse dans les années 1950 et sur les causes de sa perte d’influence dans les années 1970 qu’il n’impute pas au DSM-III, mais aux psychanalystes américains eux-mêmes. Il tente de démontrer que le DSM-III et les DSM suivants n’ont pas entraîné de changement de paradigme, au sens que lui donne Thomas Kuhn. Conclusion L’histoire de la psychiatrie américaine montre qu’il y a peu de chance pour que s’éteignent les conflits entre les tenants d’un cerveau, encore très mal connu, et ceux d’un esprit, souvent bien mal défini, tant que nos connaissances dans le domaine des troubles mentaux seront aussi minces qu’elles le sont aujourd’hui. Objective Very often, the brain and the mind are objects of controversy in the world of psychiatry. The history of American psychiatry is instructive in this respect. From an early date, the United States embraced psychoanalysis, invented behaviorism, promoted biological psychiatry, used biometry and produced a highly successful classification of mental disorders. The objective of this paper is the study of this history. Method The paper proposes a detailed study of the theories, practices and ideological debates in the field of American psychiatry since the 18th century, and of federal mental health policies. Results Psychiatry in the United States has distinctive features linked to the concept of manifest destiny, Protestantism and pragmatism, to the manner in which the nation was constructed (slavery, conquest of the West, economic liberalism) and to the ceaseless wars, from the War of Independence to the Middle Eastern wars, not forgetting the Civil War and two World Wars. As the nation succeeded in integrating its immigrants, it also assimilated their different cultures and their discoveries in the field psychiatry. Many theories and practices that later diffused by globalization were instigated by the nation, among others the DSMs, part of the cultural, scientific, economic and political development of the nation. Lay people were early protagonists in the constructive shifts, conflicts and anti-psychiatry tendencies. Discussion This paper examines the growing success of psychoanalysis in the 1950s and the causes behind its loss of influence in the 1970s. It does not attribute this loss to the DSM-III, but to the psychoanalysts themselves. It sets out to demonstrate that the DSM-III and later DSMs did not result in a paradigm shift in the meaning of Thomas Kuhn. Conclusion The history of American psychiatry proves that there is little chance of seeing an end to the conflicts between advocates of the brain, still poorly understood, and upholders of the mind, often poorly defined, as long as our knowledge in the field of mental disorders remains as slim as it is today. [ABSTRACT FROM AUTHOR]

Résumé Au cours des quarante dernières années, la vidéo est devenue un outil quasi quotidien pour la recherche et la clinique pédopsychiatriques. L’omniprésence des images en mouvement pose cependant des questions complexes d’un point de vue philosophique et historique : comment savoir ce qu’il se passe dans l’esprit du petit enfant ? En proposant une généalogie des images qui s’appuie à la fois sur l’histoire des sciences et sur l’histoire du cinéma, cet article tente de montrer comment serait née l’idée que l’observation vidéo pourrait permettre d’émettre des hypothèses sur ce que « pense » l’enfant. Les pratiques actuelles ont pour origine la conjonction de deux mouvements qui se développent à la fin du XIX e et au début du XX e siècles : l’essor des études sur l’enfant et l’intérêt scientifique croissant pour l’image en mouvement. Cette conjonction a contribué à l’émergence de deux traditions visuelles qui transmettent des conceptions culturelles sur l’enfant aujourd’hui encore et font dans ce sens partie de la construction d’une fiction sur l’esprit de l’enfant. Over the last forty years, video has become an almost ubiquitous tool in child psychiatric practice. The increasing presence of moving images poses difficult questions from a philosophical and historical perspective: how do we know what happens in the mind of the child? This paper addresses the question in inquiring into the historical conditions of possibility for the emergence of video as a method for generating child psychiatric knowledge. It proposes a genealogy of moving images that draws on both the history of science and film history. The article sets out with a discussion of the work of the French neurologist Guillaume-Benjamin Duchenne de Boulogne (1806–1875) as a first historical example for an interest in employing chrono-photographic means for the electro-physiological study of emotions in children. I suggest that Duchenne's work points to an ambiguous position of the child in the late nineteenth century, constituting a figure of both identification and alterity. I then show how Charles Darwin's study of infants re-situates the child in an evolutionary perspective, now taking a pivotal position for the anthropological understanding of the human condition. Darwin's work spurred experimentation with babies and infants and led to a cultural preoccupation with theories of recapitulation, as I will illustrate with the research of the British physician Louis Robinson (1857–1928). Part and parcel of this development was an interest in visualizing and recording children in both scientific and popular culture. The chrono-photographic studies of Eadweard Muybridge (1830–1904) and the 1895 film Repas de bébé by the Lumière brothers both testify to this new observational paradigm. I follow the paradigm into the twentieth century with the example of the filmic work of Arnold Gesell (1880–1961) that can be considered a precursor to current practices of video-based microanalysis. Finally, I present the point of view shot and the subjective camera as an alternative, or rather, a supplementary mode of visualization that seeks to understand the child's perspective through sympathetic insight. Films by Kurt Lewin (1890–1947) and recent scientific studies using eye-tracking methods will be set into this tradition. Overall, the paper argues that the crossroads of child studies and moving images at the turn-of-the-century have contributed to the emergence of two visual traditions that, until today, negotiate cultural ideas about the child, and, in this sense, participate in the construction of a fiction about the mind of the child. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Cet article interroge le courant de Mindfulness qui prétend repousser les limites du seuil de l’inconscient par une extension et un approfondissement du champ de conscience. Méthodes L’article est structuré en quatre parties qui correspondent à quatre modèles de la pleine conscience : la méditation, l’attention, l’activation et l’émersion en allant du contrôle par la conscience jusqu’à l’éveil involontaire du vivant. Résultats Si les lois de réaction et d’adaptation du corps vivant sont connues, les effets de l’écologisation spontanée du vivant produit des mutations dont les effets ne nous sont connus avec retard qu’à travers le vécu de conscience. Discussion En situant les différences dans les méthodologies, l’éveil du vivant dans le corps peut être bien distingué du mouvement volontaire de la conscience. Conclusions Les neurosciences méditatives et les sciences contemplatives vont au-delà de l’inconscient en admettant un principe de continuité dans le recueil de l’activité du vivant ou un principe de discontinuité dans l’émersion involontaire du vivant. Objective This paper examines the current of Mindfulness, which claims to extend the boundaries of the unconscious by extending and deepening the field of consciousness. Method The paper is structured in four parts corresponding to four models of mindfulness: meditation, mindfulness, activation and emergence, ranging from control by consciousness to the involuntary awakening of the living body. Results If the laws of feedback and adaptation of the living body are known, the effects of the spontaneous adaptation to the environment of living beings produce mutations, the effects of which are only known to us through the experience of consciousness, and entail a time-lapse. Discussion By exploring the differences in these methodologies, the awakening of the living in the body can be easily distinguished from the voluntary movements of consciousness. Conclusion Meditative neurosciences and contemplative sciences reach beyond the unconscious by implicating a principle of continuity in the inventory of the activity of the living, or a principle of discontinuity in the involuntary emergence of the living. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Nous tenterons de situer, dans le contexte psychiatrique et psychanalytique de son temps, l’article sur la genèse de « l’appareil à influencer » de Viktor Tausk. Méthode Nous verrons comment, comme sorte de synthèse de travaux sur l’évolution des délires, ont émergé des travaux structuralistes en psychiatrie qui ont permis une meilleure analyse des phénomènes automatiques dans les psychoses, qui ont été aussi au carrefour de la rencontre entre les travaux psychiatriques de Clérambault et le mouvement structuraliste en psychanalyse. Résultats À ce même carrefour, se situe le travail de Tausk sur l’automatisme dans les psychoses. Discussion Il est, de ce fait, structuraliste avant son ère, car il va au-delà de la théorie freudienne sur les psychoses de cette même période, jusqu’à une conception du « symptôme » psychotique en tant que « condensateur de jouissance ». Conclusions Ce n’est pas un hasard si à l’époque de l’automatisation de la production ont émergé des théories psychanalytiques sur l’automatisme créateur de l’inconscient, et, de plus, sur les phénomènes automatiques dans la psychose. Objectives This paper will attempt to place Viktor Tausk's famous article on the genesis of the “influencing machine” in schizophrenia within the psychiatric and psychoanalytic context of its time, particularly in relation to the concepts of structure and automatism. Methodology/approach Following the summary of Tausk's paper, we will analyse the predominant ideas concerning the evolution of delusion in time, in psychiatry of the end of the 19th century and the beginning of the 20th. We will then look into how, as a result of this evolution, some more or less structuralist works arose, which permitted, among other things, a better analysis of automatic phenomena in psychoses. These phenomena have also been at the confluence of the psychiatric work of Clérambault and the psychoanalytic structuralist movement initiated by Jacques Lacan. Results It is at the crossroad between the works of the two that we may place, though in an independent register, Tausk's pioneering work on automatism in psychoses, which is not only a commentary on the evolution of delusion, but also on the underlying element that presides over delusion, from the point of its initial hypochondriac state to the generation of persecutory delusion ideas, amongst which the existence of an “influencing machine”. Discussion Tausk's work, akin to Clérambault's and Lacan's on automatism, may thus be considered structuralist before its time. More specifically, his swan song – the “influencing machine” paper – goes beyond the Freudian theory on psychoses of the time, which focused on the psychotic's denied homosexuality, and up to the concept of the psychotic “symptom” as a capacitor of enjoyment ( jouissance ). Conclusions It is most singular that at the time of production's automation during the industrial revolution, not only were delusions modified in relation to this evolution, but there was also the development of psychoanalytic theories on the creative automatism of the unconscious, and on the automatic phenomena of the psychosis, which are related to the former. Concerning these phenomena, the influencing ideas have been the subject of several studies, by Freud and Tausk firstly, and by Clérambault and Lacan later on, each time both accusing the other of plagiarism. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les infections endodontiques sont caractérisées par leur polymorphisme microbien avec la présence d’agents pathogènes bactériens. Le but de cette étude était de rechercher la présence des levures dans les canaux des dents nécrosées avec ou sans image péri-apicale et d’étudier la sensibilité de celles-ci à une désinfection à l’hypochlorite de sodium à 2,5 %. Méthodologie Des prélèvements endocanalaires réalisés à l’aide de pointes en papier avant et après désinfection à l’hypochlorite de sodium dosée à 2,5 % sur 50 dents monoradiculées chez 38 patients. Ces prélèvements ont été ensemencés dans des boîtes de Pétri contenant du Sabouraud-chloramphénicol (SC). Elles étaient ensuite incubées dans une étuve à 37 °C pendant 48 h. La présence de levures était attestée par des colonies blanchâtres sur tout le pourtour de la pointe en papier et de blastospores à l’examen microscopique dans de l’eau physiologique entre lame et lamelle. L’identification de l’espèce se basait sur ces examens macroscopiques et microscopiques associés au test de blastèse. Résultats Des colonies levuriformes ont été isolées au niveau de 7 dents (14 %) sur les 50. Tous les échantillons positifs étaient prélevés au niveau des dents présentant une nécrose pulpaire ouverte ( p < 0,01). La seule espèce retrouvée était le Candida albicans . La désinfection immédiate du canal à l’hypochlorite de sodium à 2,5 % n’a pas montré une élimination complète des levures. Conclusion Les résultats de cette étude montrent que les canaux des dents nécrosées avec ou sans image apicale peuvent abriter des levures même après désinfection immédiate à l’hypochlorite de sodium à 2,5 %. Summary Introduction Endodontic infections are characterized by their microbial polymorphism with the presence of pathogenic agents such as bacteria. The aim of this study was to investigate the presence of yeast in the root canals of teeth with pulp necrotic with or without apical periodontitis and to study the sensibility of these at disinfection at sodium hypochlorite to 2.5 %. Methods Root canal samples, taken with paper points before and after disinfection with sodium hypochlorite dosed at 2.5 % on 50 single rooted teeth in 38 patients, were seeded in petri dishes containing Sabouraud Chloramphenicol (SC) (Conda Laboratories, Madrid). These stains were incubated in an incubator at 37 °C for 48 hours. The presence of yeast was confirmed by white colonies on the entire circumference of the tip paper. The identification of species was done by macroscopic and microscopic examinations associated with Blastese test. Results The yeast colonies were isolated from 7 teeth (14 %) out of 50. All positive samples were from teeth with an open necrotic pulp ( P < 0.001). The only species found was Candida albicans . Immediate disinfection with sodium hypochlorite at 2.5 % did not show a complete elimination of yeasts. Conclusion The results of this study show that the canal of necrotic teeth with or without apical periodontitis may shelter yeasts even after immediate disinfection with sodium hypochlorite 2.5 %. [ABSTRACT FROM AUTHOR]

Résumé Objectifs L’auteur examine l’expérience subjective de patients orientés vers la greffe ou l’implantation de prothèses cardiaques. Cet aspect devient pertinent dans un contexte marqué autant par le poids de la réalité technique de la procédure que par une certaine banalisation des processus d’adaptation de ceux qui y ont assujettis, banalisation issue de l’utilisation courante des procédures de greffe. L’étude ne visait pas l’identification de diagnostics psychiatriques. Méthode Diverses représentations mentales associées à l’expérience de patients suivis à différents moments de leur trajectoire ont été élicitées dans le cadre d’un suivi systématique pour ces procédures chirurgicales. Cet essai clinique synthétise divers scénarios psychiques issus de ces expériences de vie. Résultats Ces scénarios sont groupés en quatre secteurs selon la trajectoire des patients. Un premier secteur concerne les patients suivis lors de l’orientation vers la transplantation cardiaque ou pulmonaire ; un deuxième secteur appartient à ceux qui sont suivis durant la période immédiatement après la greffe ; un troisième secteur concerne les patients suivis au long cours. Un quatrième secteur est celui examinant l’expérience des patients avec des implants cardiaques. Ces scénarios reflètent l’expérience personnelle de certains patients et ne peuvent être identifiés précisément dans tous les cas. Discussion Ces scénarios sont des trames représentatives qui permettent au patient, au plan de l’imaginaire, d’intégrer la greffe ou l’implant dans sa trajectoire de vie et dans sa réalité psychique. Cette intégration est requise dans la mesure où la procédure devient une nouvelle maladie chronique. Conclusion Ce travail sur l’expérience subjective a surtout une visée heuristique pour distinguer deux registres différents de l’intégration de la greffe, l’accommodation et l’adaptation. Le pôle de l’adaptation concerne la réalité matérielle objective et les procédés pour y faire face ; le pôle de l’accommodation concerne la réalité psychique qui vise à infléchir la réalité extérieure vers l’émotion afin d’éviter l’angoisse. Ce sont des registres en tension dans des pôles opposés que le scénario cherche à amalgamer dans une recherche de sens personnel. Objectives The paper focuses on the subjective aspect of patients’ experiences when undergoing organ transplantation or implantation of cardiac prostheses (ICD, Heart Mate II). This issue has become relevant because the technical side of the procedure easily overshadows the personal process of integrating a new organ or device. The study was not intended to establish psychiatric diagnoses. Method The paper reviews various mental scenarios derived from clinical assessments of patients whose various mental representations associated with their experiences were elicited. Our protocol provides for each patient undergoing these surgical procedures to be systematically seen and followed according to their needs. Results The mental scenarios were assigned to four different groups identified according to various moments in patient itineraries. The first group concerns patients waiting for a transplant; the second concerns reactions during the immediate postoperative period; the third concerns long-term adjustment after surgery. The last group is related to reactions after the implantation of cardiac devices. The scenarios observed reflect the personal experience of some patients, but did not necessarily apply to all cases. Discussion These scenarios are distinct from immediate reactions occurring at very early stages in each phase. The psychic integration of a transplant develops alongside the impingements of external reality. Scenarios enable the patient to fit the surgical experience into his or her own thread of life and psychic reality. This integration is necessary because transplantation or implantation are a new form of chronic illness. Conclusion This paper has a heuristic aim, since psychic integration is subject to tension between two opposing forces. The first of these is the external pole of adaptation geared to managing material reality, where coping is a rational process; the second is the internal pole of accommodation, geared to manage psychic reality, where external reality is shaped to fit emotions so as to avoid anxiety. These scenarios attempt to integrate both forces in order to give meaning to the surgical experience and integrate it into the broader thread of the patient's life. [ABSTRACT FROM AUTHOR]

Résumé Introduction et objectifs La dénutrition et la fragilité sont des problèmes de santé publique fréquents, en particulier chez les personnes âgées. Le ministère des Affaires sociales et de la Santé a décidé, en 2012, de promouvoir un programme pilote de sensibilisation comprenant la réalisation de 10 conférences et de trois outils électroniques ou papier sur ce sujet. Il a sollicité pour cela la Société francophone nutrition clinique et métabolisme (SFNEP), qui a choisi pour mettre en place cette action le réseau de nutrition LINUT, implanté en région Limousin, la 2 e région la plus âgée d’Europe. Méthodes Le programme a été validé par le ministère des Affaires sociales et de la Santé et la SFNEP. Les conférences avaient pour cible les professionnels de santé et le grand public, et étaient annoncées aux médias. Elles ont été évaluées par un index de satisfaction, un test de connaissances avant/après et un questionnaire appliqué un ou trois mois après la manifestation. Les outils étaient : la proposition de mettre sur les sites Internet des institutions partenaires du réseau un lien avec le site grand public de la SFNEP, la création de 12 fiches simples, électroniques et papier, traitant de divers aspects de la dénutrition chez les personnes âgées, la réalisation d’un livre de recettes en texture mixée de fruits et légumes crus, incluant leur composition nutritionnelle et un visuel. Résultats Onze conférences ont été organisées, regroupant 947 personnes (moyenne par conférence : 86,1 ± 55,4 auditeurs) sur l’ensemble de la région. La fréquentation a été plus forte si les conférences étaient adossées à des ateliers ou à la journée régionale des Comités de liaison alimentation nutrition (CLAN). Les appréciations subjectives et les tests avant/après ont été favorables, alors que le questionnaire à distance est apparu comme inadapté. Seulement 19 % des institutions sollicitées ont accepté d’intégrer le lien avec le site de la SFNEP. Les fiches électroniques et papier ont été largement diffusées et l’ouvrage de produits crus mixés a regroupé 50 recettes. La presse régionale a rendu compte de ces réunions en publiant 16 articles sur ces actions, et un reportage de la chaîne de télévision TF1 a été réalisé lors d’un atelier. Le budget alloué a été consommé conformément aux prévisions. Conclusion Un programme de ce type est applicable, et paraît efficace quant au nombre de personnes concernées par les conférences, la diffusion des outils et l’impact médiatique. Introduction and objectives Malnutrition and frailty are frequent public health problems, in particular in the elderly people. The French Ministry for the Social Affairs and Health (MSAH) decided in 2012 to promote a pilot program including the realization of 10 conferences and three electronic or paper tools on this subject. It requested in this direction the French-speaking Clinical Nutrition and Metabolism Society (SFNEP), which chose for its application the nutrition network LINUT, established in area of Limousin, the 2nd oldest area of Europe. Methods The program was validated by the MSAH and the SFNEP. The conferences had as a target the health professionals and the general public, and were announced with the media. They were evaluated by an index of satisfaction, a general knowledge before/after test and a questionnaire applied one or three months after the conferences. The tools were: the proposal to put on the websites of the institutions partners of the network a link with the site general public of the SFNEP, the creation of 12 simple, electronic and paper cards, treating various aspects of malnutrition in the elderly, the realization of one recipe book in mixed-texture of raw fruit and vegetables, including their nutritional composition and visual. Results Eleven conferences took place, involving 947 people (average: 86.1 ± 55.4) on the whole of the area. The frequentation was stronger if the conferences were leaned with workshops or the regional day of the Liaison Committees for Alimentation and Nutrition (LCANs). The subjective appreciations and the before/after tests were favourable, whereas the remote questionnaire appeared unsuited. Only 19% of the requested institutions agreed to integrate the link with the site of the SFNEP. The electronic and paper cards were widely diffused. The book included 50 mixed-texture cooking recipes. The regional press published 16 articles on these actions, and a TF1 report was carried out at the time of a workshop. The allocated budget was consumed in accordance with the forecasts. Conclusion A program of this type is applicable, and appears effective as for the number of people concerned with the conferences, the diffusion of the tools and the media impact. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Le suicide est un enjeu majeur de santé publique et les jeunes y sont particulièrement exposés. Cette méta-synthèse explore le vécu de l’expérience du suicide chez l’adolescent et le jeune adulte afin de mettre en perspective l’expérience du jeune suicidant et les modalités de prises en charge. Méthode La méthode est une analyse thématique (Thematic Synthesis) de 30 articles qualitatifs interrogeant des adolescents et les jeunes adultes, obtenus par une recherche systématique sur les principaux moteurs de recherche en psychiatrie. La qualité des études a été évaluée à l’aide du Critical Appraisal Skills Programme (CASP). Résultats L’analyse dégage six thèmes organisés autour de deux principaux axes d’expérience. La dimension interpersonnelle regroupe le sentiment de différence et de rejet, le vécu d’incompréhension et la relation à l’autre ; la dimension individuelle regroupe le vécu de dépressivité, le contrôle de soi et la perception de soi. Conclusion L’expérience du suicide est intimement liée au vécu de la relation à l’autre, et cette relation est au cœur du processus thérapeutique. Les prises en charges doivent d’avantage prendre en compte cette dimension du lien et de la nécessité de travailler avec l’entourage du jeune. Les recherches sur le sujet gagneraient à mieux prendre en compte les interactions entre les éléments socioculturels et l’expression de la souffrance conduisant au suicide. Aims Suicide is a major public health issue, one particularly affecting youth. This meta-synthesis of qualitative research studies the experience of adolescent and young adult suicide in order to suggest therapeutic propositions. Method Thematic analysis included 30 qualitative papers elicited by web searching on principal psychiatric databases. The papers questioned adolescents and young adults. Quality appraisal used the Critical Appraisal Skills Programme (CASP). Results The results are organized around two main axes. The relational experience included three themes: feelings of difference and rejection; the experience of incomprehension; and the relation to others. The interpersonal experience included three themes: the experience of distress, self-control and self-perception. Conclusion The experience of suicide is bounded to the relation with others, and this relation is at the center of the therapeutic process. Therapists have to keep in mind this relational dimension and the necessity of the work with families and peers. Researchers have to take account of sociocultural impact on the expression of distress. [ABSTRACT FROM AUTHOR]

Résumé Thérèse Lempérière a accompagné l’émergence de la psychopharmacologie. Ses travaux concernent autant l’efficacité des psychotropes (antidépresseurs, neuroleptiques) sur les différents symptômes que l’induction de symptômes par certaines substances psychotropes (amphétamine, psilocybine). Ou encore l’étude des effets neurologiques des neuroleptiques et l’analyse de l’apport des traitements retards. Son regard sur la pharmacologie est celui d’une clinicienne et reste en cela très actuel : l’analyse fine clinique des effets des psychotropes sur le psychisme et le système nerveux central, qui a initialement permis d’affiner les indications des molécules, continue à être aujourd’hui la principale source permettant d’améliorer la connaissance en psychiatrie et sciences de la cognition, mais aussi et surtout de rechercher de nouvelles pistes thérapeutiques, au-delà des catégories diagnostiques et en dehors de leur indication première, ou de rechercher la meilleure adéquation du profil thérapeutique à un profil clinique. Objectives This paper is a tribute to Thérèse Lempérière's legacy regarding the study of psychotropic substances and an analysis of the lessons from her work for the future of psychopharmacology. Materials and methods All her historical papers, mainly published in French journals, were reviewed as well as the summary of “titles and works” written by her. Rather than a comprehensive review, we have selected some papers in order to cover the various domains she addressed and to highlight some main characteristics of her work and envision. The paper also analyze her work in the context of the remarkable progresses of psychopharmacology in the second part of the 20th century as well as new perspectives for future innovations. Results Thérèse Lempérière started studying psychotropic drugs in 1953, in the department where the antipsychotic effects of chlorpromazine were discovered. In the same line as these pioneering observations, her work widely covers the study of various compounds, with a specific interest for clinical descriptions of therapeutic effects in patients of new drugs as well as induction of symptoms by substance of abuse in patients or healthy volunteers. She explored every classes of the classification proposed by J. Delay in 1957 (adopted by the 1961 World Congress of Psychiatry) i.e. psycholeptics including neuroleptics and mood stabilizers, psychoanaleptics such as nooanaleptics (amphetamine) and thymoanaleptics (antidepressants) and psychodysleptics especially psilocybine. Regarding amphetamine, T. Lempérière discussed the differential diagnosis between pharmacopsychose and what she called ‘amphetaminic pseudopsychosis’ when psychosis persist after withdrawal and proposed that amphetamine reveals previously quiescent predisposition to schizophrenia. She underlined the bidirectional relation: amphetamine induces psychosis but also amphetamine as a self-medication for early dysfunction of schizophrenia. A picture very similar to current view on cannabis precipitated psychosis or self-medication by cocaine. T. Lempérière studied several classes of antidepressant from the early tricyclic to very recent ones. In the ‘two-year of experience with imipramine’ article, she reviewed the best indications and factors of good response (melancholia, simple depression, women) while imipramine has low efficacy in severe melancholia and hypochondria. She proposed the association of imipramine to reduce the number of ECT and indicate some efficacy in OCD. The descriptions of psilocybine in healthy volunteers and patients are full of information regarding the individual variability and the semiology of psychotic-like experiences induced by psilocybine (illusions, “hallucinose”, pseudohallucinations rather than hallucinations). Of course, Thérèse Lempérière's explored the neuroleptics, many of them, with a special focus to analyze the differential therapeutic profile of each molecule, in order to improve the adequacy to the patient's profile. A main contribution was the study of reserpine, starting in 1954, that, together with the observation with chlorpromazine, contributed to the definition the of neuroleptics’ class. These included the presence of extra pyramidal signs, which Thérèse Lempérière also explored, including tardive dyskinesia. She rapidly recommended to prescribe neuroleptic at the minimal efficient dose and to avoid systematic prescription of anticholinergic drug. Thérèse Lempérière promoted the use of long acting neuroleptics early in the disease, since they prevent treatment interruption and facilitate the alliance. Regarding the mood stabilizers, Thérèse Lempérière contributed to the introduction of valpromide and valproate in psychiatry. Conclusions Thérèse Lempérière is a pioneer woman in French Psychiatry, and her legacy is not restricted to the field of psychopharmacology. Her remarkable contribution is mainly due to her clinical vision and analysis. The overview of the Thérèse Lempérière's contribution to psychopharmacology underline several features of the early history of psychopharmacology: the origin of psychotropic drugs out of neurosciences (antibacterial, antiparasitic, antihypertensive, etc.), the close relation between clinician and chemists from pharmaceutical company, rapid transfer to the clinic and rapid feedback to the pharmaceutical companies, the fine clinical (phenotypic) descriptions, the use of psychotropic drugs to dissect psychiatric syndromes. These are invaluable lessons to apply for the future developments of psychopharmacology. They plead for a reinforcement of translational psychiatry with always more bidirectional relations between clinics and basic sciences and advocate for reopening the borders between psychiatry and other medical disciplines. [ABSTRACT FROM AUTHOR]

Résumé Objectifs La méthode phénoménologique se présente moins comme une technique thérapeutique que comme une attitude théorico-clinique dont les auteurs s’efforcent de dégager les aspects essentiels, cherchant à montrer comment l’esprit phénoménologique se traduit au niveau de la sensibilité clinique et de la façon d’être présent en consultation. Méthode L’approche phénoménologique porte une attention prioritaire à la façon d’être au monde du patient, à la relation qui le lie à soi, aux autres, à l’historicité de sa vie, autrement dit aux fondements même de son expérience vécue. Ces dimensions, rarement verbalisées de façon explicite, sont essentielles lorsqu’il s’agit de comprendre des phénomènes comme la difficulté fondamentale de contact avec autrui, l’expression somatique d’une souffrance psychique ou les symptômes plus « aberrants » d’une maladie. L’accès à ces dimensions s’ouvre dans la rencontre intersubjective, élément constitutif et fondamental de l’approche phénoménologique. Les auteurs cherchent donc à mettre en évidence comment, dans cet horizon intersubjectif, le travail psychopathologique et thérapeutique se pratique. Résultats Différents moments sont détaillés et illustrés par des vignettes cliniques : la mise en question de la possibilité même de la rencontre dans la maladie et le soin nécessaire à sa ré-émergence ; le travail de compréhension partagée du monde de l’autre et de la logique singulière qui sous-tend sa constitution ; l’attention au corps comme foyer co-constituant de la présence ; l’élaboration d’un diagnostic où la maladie se définit en référence aux dimensions de notre condition humaine commune, et non seulement en rupture avec cette dernière. Si, dans une perspective phénoménologique, l’intersubjectivité est l’espace de jeu où non seulement la prise en charge thérapeutique mais déjà le diagnostic s’élaborent et cherchent leur voie d’accomplissement, force est de reconnaître la radicalité de l’engagement en première personne du clinicien. Engagement dans l’avènement même, parfois précaire, d’une rencontre avec le malade ; engagement dans le fait de sentir et de penser ce qui se donne dans cette rencontre. Discussion Les auteurs dégagent les lignes de tension émergeant de la confrontation entre l’« idéal » phénoménologique et la réalité clinique, et insistent sur l’aspect transversal de la phénoménologie qui, sans être une technique en soi, veille à ce parti pris anthropologique auquel Minkowski nous invite : exercer une psychopathologie « à deux voix », ancrée dans la « rencontre humaine ». Le clinicien d’inspiration phénoménologique cherche à éclairer l’expérience du patient quant à sa forme de présence au monde, avec ses soubassements spécifiques au niveau du corps vivant-vécu. Il dégage la logique d’existence qui sous-tend les symptômes de la maladie. Il cherche avec l’autre à réinscrire ses modes d’être dans une trame partageable de sens, en veillant à ne pas renforcer l’aliénation par une description qui quitterait le terrain de l’intersubjectivité. Conclusion Toute souffrance psychique constitue en soi une forme particulière d’isolement ou de trouble intersubjectif. Tout « traitement » en psychiatrie a dès lors à se soucier de l’espace de rencontre au sein duquel les souffrances et les défaillances se déclarent. Il importe que celles-ci prennent un sens partagé – ce par quoi s’amorce d’un seul tenant le mouvement de compréhension et de soin. Il s’agit de pouvoir passer d’une situation éprouvée par le sujet comme le mettant « à part », aux marges de l’humain, à une situation où il puisse se sentir reconnu et reçu parmi « la communauté des hommes », ayant sa place dans un monde humain partagé. Aims The phenomenological method is not so much a therapeutic technique as a theoretical/clinical attitude . This paper endeavours to set out its main aspects, and to show how the phenomenological approach translates into clinical terms and the clinician's presence in consultation. Method The phenomenological approach gives priority to the patient's manner of being in the world, to his or her relationships with self and others, and to his/her life history, in other words the very foundations of the person's life experience. These dimensions, which are rarely put explicitly into words, are essential for the understanding of phenomena such as difficulty establishing contact with others, somatic expressions of psychic suffering, or the more “aberrant” symptoms of an illness. Access to these dimensions is gained in the course of intersubjective encounters, a fundamental component of the phenomenological approach. This paper thus sets out to show how, in this intersubjective perspective, psychopathological and therapeutic work can be undertaken. Results Different moments are detailed and illustrated by clinical vignettes: a questioning of the actual possibility of the encounter in the setting of an illness, and the care required to let it re-emerge; the work on a shared understanding of the world of the Other, and the singular logic underpinning the way it is formed; attention to the body as the shared receptacle of presence; the elaboration of a diagnosis in which the illness is defined in reference to the dimensions of our shared human condition, rather than merely in contrast or contradiction with it. While in a phenomenological approach intersubjectvity provides the field for interplay, where not only the therapeutic provision but also the upstream diagnostic process are deployed and achieved, it must also be conceded that there is a radical personal implication by the clinician. There is an implication first in the actual occurrence of the encounter with the patient, sometimes very insecure, and then in feeling and apprehending what is played out in that encounter. Discussion The authors demonstrate the tensions emerging from the confrontation between the phenomenological “ideal” and clinical reality, with emphasis on the cross-sectional aspects of phenomenology, which, although it is not a technique as such, is attentive to the anthropological stance suggested by Minkowkski: practising psychopathology with “two voices”, rooted in the human encounter. The clinician working along phenomenological lines seeks to cast light on the patient's experience in its relationship to the form of his or her presence in the world, with its specific underpinnings in the living-experiencing body. The clinician thus distinguishes the logic of existence that underpins the symptoms of the illness, endeavouring with the patient to place his/her modes of being in a construction within which meaning can be shared, while at the same time taking care to avoid reinforcing alienation by descriptions overstepping the intersubjective domain. Conclusion Any psychic suffering is a particular form of isolation or intersubjective disorder. Any “treatment” in psychiatry should therefore attach importance to the space for encounter where these sufferings and shortfalls can be addressed. It is important for suffering and shortfall to take on a shared meaning, since this enables both understanding and care provision. The need is to move from a situation experienced by the subject as placing him or her “apart”, on the fringes of humanity, to a situation where the subject can feel recognised and integrated “into the society of men”, with a place in a shared human world. [ABSTRACT FROM AUTHOR]

Résumé Le lien entre l’état psychologique et les appartenances culturelles est central dans la littérature américaine sur l’adoption internationale. Le sentiment de fierté des adoptés vis-à-vis de la culture du pays de naissance permettrait une meilleure estime de soi et serait un facteur protecteur face aux expériences de racisme. Les parents sont donc encouragés à enseigner à leur enfant adopté la culture de son pays de naissance afin de favoriser son bien-être psychologique. Ces études s’inscrivent dans un contexte américain de valorisation des spécificités culturelles de groupes minoritaires, mais laissent peu de place au discours des personnes adoptées. Méthode Cette revue de 50 articles met l’accent sur le point de vue des personnes adoptées sur leurs appartenances culturelles. Résultats À ce jour, il est impossible de conclure à un lien de causalité direct entre les appartenances culturelles et l’état psychologique. Les adoptés évoquent des expériences de discrimination du fait de leur différence physique. Leur curiosité vis-à-vis du pays de naissance est variable et pour certains les activités culturelles doivent être suggérées mais non imposées par leur entourage. Au-delà du lien au pays de naissance, l’affiliation à un groupe de personnes adoptées peut être une appartenance culturelle forte. À l’âge adulte, certains adoptés s’engagent dans une réappropriation culturelle délibérée. Conclusion La littérature anglo-saxonne présente l’intérêt de considérer les tensions sociales et psychologiques que peuvent vivre les adoptés. Néanmoins, leurs propos contredisent certains partis pris théoriques et soulignent les limites méthodologiques et conceptuelles de ces études. Nous proposons des perspectives pour de futures recherches et leurs applications cliniques. Background The link between psychological development and cultural identity is central to American literature on international adoption. It is claimed that adopted children's pride in the culture of their country of birth improves their self-esteem and helps them to cope with experiences of racism. Parents are therefore encouraged to teach their adopted children the culture of their country of birth in order to improve his psychological well-being. These studies are part of the American context of promotion of minorities cultural specificities, but they widely overlook adoptees’ opinions. Method This review of 50 papers focuses on adopted children's point of view about their cultural belonging. Results To date, it is not possible to deduce a direct causal link between cultural identity and psychological development. Adoptees mention experiences of discrimination or racism because of their physical differences. Nevertheless, the expectations and curiosity about birth culture seem to vary among adoptees and depending on time and age. Some claim cultural activities should be proposed but never imposed by the relatives. Beyond the link to birth culture, membership in a group of adoptees can be a strong cultural identity. In adulthood, some adoptees engage into a deliberate cultural reclamation. Conclusion The papers reviewed describe the social and psychological tensions to which adopted children are submitted. Nevertheless, adoptees’ narratives contradict some theoretical hypotheses and emphasize the methodological and conceptual limitations of these studies. We offer perspectives for future research and clinical applications. [ABSTRACT FROM AUTHOR]

Résumé Les noms communs de « psychose » et de « névrose » ont été transmis par des générations de praticiens pour rester d’un usage habituel dans les services de psychiatrie clinique. Mais comment ces mots dont le signifié moderne débute avec Freud auraient-ils pu rester concordants jusqu’à notre clinique contemporaine ? Quels sont les arguments pour ou contre la pérennité de ces appellations ? Après un bref historique resituant les origines de ces termes de « névrose » et de « psychose », nous détaillons l’analyse syntaxique et lexicale de leurs définitions rapportées par quatre ouvrages célèbres de notre psychiatrie francophone (H. Ey, T. Lempérière et J. Guelfi, P. Juillet). La réflexion du psychiatre par rapport à l’interrogation définitoire des « névroses » et des « psychoses » est concordante à la critique phénoménologique du diagnostic psychiatrique : ce que l’on appelle « névrose » et « psychose » traduit une intuition clinique globale dont la caractérisation définitionnelle signifiée est difficile. Dans notre clinique contemporaine, les termes de « névrose » et de « psychose » sont employés par des praticiens d’horizons et de pratiques divers qui partagent, ou non, les mêmes a priori conceptuels : ce que le clinicien appelle couramment « névrose » comme « psychose » est plutôt de l’ordre de la typologie diagnostique que du modèle ou du concept. Background We seek to establish whether there is a consensus definition of the terms “neurosis” and “psychosis” among contemporary writers of French language. How words whose modern meaning begins with Freud might have remained consistent to our contemporary clinic? Method A research methodology like critical review of the literature was not possible because of a too small number of papers referenced with the keywords of “neurosis” or “psychosis”, papers which offered still more rarely explicit definition or implied terms neurosis and psychosis. We therefore opted for a methodology of analysis of lexical and syntactic definitions fields recorded within four famous works: The Manuals by Henri Ey, Thérèse Lempérière and Julien Guelfi, and the Dictionary of Psychiatry by Pierre Juillet. Results Theoretical benchmarks used are not directly explained even if the lexical analysis discovers a multitude of implicit conceptual bases. Parsing found that the terms “neurosis” and “psychosis” on the one hand, and different conceptual or more generically the various notions bases referred to by the authors on the other hand, are not connected by logical links explicit characterizing relations involvement, cause or consequence, but remain joined or juxtaposed. In addition, the nature of the relationship between the definition of “neurosis” and the “psychosis” is not obvious: the separators served most consistent result from the subjectivity of the interview. Discussions The reflection of the psychiatrist in relation to the definitional question of “neuroses” and “psychoses” is consistent with the phenomenological critique of psychiatric diagnosis: what is called “neurosis” and “psychosis” reflects a clinical intuition whose definitional characterization is difficult. The reference to the symptom, syndrome or disease, so diagnosis may be here surpassed by “category”, “type” or “structure”. Conclusions While definitions of what is called “neurosis” and “psychosis” in the future could change depending on the societal context in which they are expressed, it should be noted that since Freud clinical impression of what the essence of “neurosis” or “psychosis” is passed from one generation to another practitioner rather independently of these definitional possibilities. In our contemporary clinical terms “neurosis” and “psychosis” are used by practitioners of various backgrounds and practices that share or not the same conceptual a priori: what the clinician commonly called “neurosis” as “psychosis” is more an intuitive prototype than a model or a concept. [ABSTRACT FROM AUTHOR]

Résumé Cet article part d’une réflexion concernant des écarts importants obtenus chez deux auteurs pionniers dans la question du profilage géographique (D. Canter et K. Rossmo), le premier étant Anglais et le second Canadien. Si leur postulat de base était identique, leurs résultats divergeaient. Nous nous sommes alors intéressés à la question de l’environnement immédiat, les écarts topographiques et l’urbanisme dans ces continents pouvant être une des variables expliquant certaines des différences constatées dans ces comportements et la forme qu’ils revêtaient entre les deux côtés de l’Atlantique. Si le rôle joué par l’environnement primaire, les premières interactions avec les parents, n’est pas négligeable dans le développement psychoaffectif et la constitution de la personnalité d’un individu, nous nous focaliserons à travers ces pages sur la place tenue par l’environnement urbain, au sens premier du terme « environnement », dans les actes d’agressions sexuelles sérielles. La question en filigrane étant de considérer en quoi la perception de l’espace des auteurs d’agressions sexuelles sérielles (AASS), leurs « cartes mentales », dépendrait essentiellement de la culture dans laquelle ils se développent et comment cela pourrait avoir des incidences sur leurs zones « d’action » ? La forme de ce travail est celle d’une revue de la littérature, en partie du fait de la difficulté d’accès à cette population pour des travaux criminologiques. Les illustrations cliniques proviennent soit de ressources personnelles, après modifications des noms, soit livresques. Ce travail ne proposera pas de valeur statistique mais plutôt une hypothèse de réflexion. Objectives This article deals about an aspect not taken into consideration often when considering violent sexual offenses. The term “crime scene”, which got widespread into common language, depicts all the elements collected at the place where a crime occurred and which could later become pieces of evidence. However, the place by itself, the link between the offender and the place, the influence of the urban environment and the cultural aspect of it do not receive that much attention in the literature. This paper originates from a comparison of the work of two psychologists specialized within the field of geoprofiling, D. Canter and K. Rossmo, the latter being a Canadian citizen and the former an Englishman. If their postulates were similar, their findings however diverged. If primary caretakers and early interactions are not to be underestimated regarding their roles into the personality development, we will in these pages consider the urban environment by itself in serial sexual offenses. Methods Due to a restricted access to this type of patients, we mainly focused our hypothesis on a literature review and a few patients of ours, met during previous research works. Concepts used in this paper overlap various fields such as psychodynamic, criminology, criminalistics, psycho-sociology and even urbanism. We focused in this paper onto the importance of the culture and the urban concrete environment as probable variables explaining these discrepancies observed into the behavioral patterns and distances covered by Serial Sex Offenders between the two shores of the Atlantic. The underlying question being how their space conception, their “mental maps”, depends of the culture they were bred in and how it could have an incident onto their offense zones? Results The findings highlight an inherently cultural variation of the spatial conception, but also how the space is built up and integrated between the USA (and all the large and historically “recents” territories) and Europe. American sexual serial offenders are more likely to cover larger distances, almost twice as much than their European counterparts. It seems that our hypothesis is relevant; a cultural distinction may exist on the way spatial environment is perceived and could thus have incidences into the offense patterns. Conclusions With the development of the E.U., our spatial conceptions as European citizens evolve. Thanks to mass transportation, and the Erasmus programs, it is not uncommon for an Italian individual to study in Scotland or Finland for instance. This is of some importance into how the spatial mobility is becoming more thinkable, and somehow how it induces a shrinkage of the distance into the mental mapping process. [ABSTRACT FROM AUTHOR]

Résumé Objectifs L’objectif de cet article est d’analyser les limites de la représentation et les caractéristiques des fictions dans leurs relations à la métapsychologie freudienne. Cette approche comporte ainsi une dimension épistémologique qui interroge les sources et les modèles de la fiction, notamment dans l’élaboration du concept de pulsion. Méthode Cet article correspond à une recherche théorique sur les fictions et les fondements des concepts psychanalytiques, à travers l’analyse épistémologique et historique de la métapsychologie freudienne. La théorie des pulsions est située dans le processus historique de sa construction. Résultats Cette étude démontre que les fictions correspondent à une approche heuristique pour penser « quelque chose d’inconnu ». Cet article suggère aussi que les fictions métapsychologiques ont différents modes d’existence : « fictions théoriques », « concepts fondamentaux », mythes… Ainsi, d’importants arguments en faveur des fictions mythologiques sont exposés : dans le cas de la pulsion de mort, les mythes peuvent fournir une représentation des pulsions et ainsi donner une place à ce qui échappe au savoir scientifique. Discussion L’article propose une approche synthétique du positionnement fictionaliste à l’œuvre dans L’interprétation du rêve . La caractérisation des « fictions théoriques » est reliée à un champ philosophique et aux principaux précurseurs du fictionalisme freudien : Kant et Hans Vaihinger. Un aspect important consiste à montrer comment la métapsychologie intègre un questionnement philosophique concernant la possibilité de la représentation. La question des « concepts fondamentaux » est abordée : la réflexion se concentre alors sur la notion de « convention » et la signification du « concept-limite ». Si le modèle freudien de 1915 est clairement scientifique et conceptuel, l’approche métapsychologique de 1920 devient fondamentalement mythologique et narrative. Ce tournant épistémologique est examiné et sa signification est discutée. Conclusion Cet article propose une conclusion générale : l’épistémologie freudienne de la fiction repose sur une aporie qui est au cœur de la possibilité même de la représentation métapsychologique. D’un point de vue épistémologique, la métapsychologie formule et maintient une position critique sur la question des « concepts fondamentaux » et des constructions théoriques : cette conclusion propose de faire des liens entre le problème des fictions et la question de la croyance. Aims The purpose of this study is to analyse the limits of representation and the characteristics of fictions in Freudian metapsychology. As such, this paper has an epistemological angle, which looks at the sources and models of fiction in the elaboration of the drive concept. Method This article is a theoretical research on fictions and foundations of psychoanalytical concepts, through an epistemological and historical analysis of Freudian metapsychology. The drive theory is located in the process of its construction. Results This study shows that fictions correspond to an heuristic approach to thinking “something unknown”. This article suggests that metapsychological fictions have different modes of existence: “theoretical fictions”, “fundamental concepts”, myths… In this paper, important arguments for mythological fictions are exposed: in the case of death drive, myths may provide a representation of drives and a place for that which escapes the realms of scientific knowledge. Discussion The article contains a brief overview of the fictional position in The Interpretation of Dreams . The characterization of “theoretical fictions” is connected with a philosophical field and the principal precursors of Freudian fictionalism: Kant and Hans Vaihinger. An important aspect is to show how metapsychology integrates a philosophical investigation of the possibility for representation. The question of “fundamental concepts” is examined: the focus concerns the notion of “convention” and the significance of “limit-concept”. If the 1915 drive model is clearly scientific and conceptual, Freud's 1920 approach is fundamentally mythological and narrative. This epistemological shift is examined and its significance is discussed. Conclusion This paper proposes a general conclusion: the Freudian epistemology of fiction is based on an aporia which is present at the core of the possibility of metapsychological representation. From an epistemological point of view, metapsychology formulates and maintains a critical position on the question of “fundamental concepts” and theoretical constructions: this conclusion connects the problem of fictions with the question of belief. [ABSTRACT FROM AUTHOR]

Résumé Dans les procédures d’interprétation des scores des échelles de Wechsler, on recommande d’évaluer la cohésion des indices pour apprécier leurs valeurs cliniques. On considère que l’interprétation d’un score composite n’a de sens que s’il est cohésif. Le premier objectif de cet article est de démontrer que les valeurs seuils proposées (23 points et 5 points) par certains auteurs pour évaluer la cohésion des scores composites sont incorrectes, et que d’autres valeurs doivent être préférées. Plus important, le second objectif est de démontrer que l’argument selon lequel un score composite non cohésif ne peut donner lieu à une interprétation, n’est pas tout à fait correct. Les scores composites restent pertinents qu’ils soient cohésifs ou non. When interpreting the composite scores of the Wechsler Intelligence scales, some authors recommended to determine whether the composite scores are unitary or not. It has been suggested that when variability among scores is too large, then the composite score does not provide a good estimate of the psychological attribute, and is not interpretable. The first objective of the paper is to demonstrate that the cut-off threshold values (23 points and 5 points) proposed by some authors are inadequate. Other cut-off threshold values should be used. Most importantly, the second goal of this paper is to demonstrate that the notion of unitary abilities that was guiding principle of interpretation is also inadequate. Indeed, nonunitary index still provides relevant information. [ABSTRACT FROM AUTHOR]

Résumé La traduction française du DSM-5 sera publiée (Elsevier) en juin 2015. Cette communication résume l’historique des traductions françaises des DSM depuis le DSM-III en 1980. Nous sommes restés fidèles aux principes antérieurement retenus, à savoir traduire plutôt qu’adapter et respecter – sauf exceptions – le style de la version originale, avec ses répétitions systématiques. De nombreux exemples sont donnés des choix que nous avons effectués. La seconde partie concerne l’utilisation des quelque 65 outils psychométriques recommandés par les auteurs, en libre accès gratuit sur Internet, pour la plupart non traduits et non validés, pour lesquels les règles méthodologiques d’adaptation et de validation ne pourront pas être respectées. The French translation of DSM-5 will be published by Elsevier Masson in June 2015. This paper summarizes the historical background of the French translations of DSM since 1980 (DSM-III). The translation team has remained true to the principles of previous translations, namely choosing scientific accuracy rather than literary adaptation, and respecting the unique style of the Handbook, with its systematic repetition of phrases and expressions referring to diagnoses. There were very few real problems of translation. Some terms, however, have been the subject of various translation proposals. Other terms have been translated differently depending on context, reflecting the fact that most English and French words are polysemic rather than univocal. Many examples are given of the choices we have made. The second part of the paper is about the emerging measures recommended in DSM-5 section III. These tools (more than 65 questionnaires, inventories or rating scales) can be accessed freely online. Their use is recommended to “enhance the clinical decision-making process, with level 1 cross-cutting self/informant related measures that serves as a review of systems across mental disorders, and level two disorder-specific severity measures”. Most of these assessment measures are not validated in French. The methodology for validating translated inventories or rating scales has been well known since the early sixties. And International guidelines have been recently published in this field. These validation studies are long, difficult and costly. They implicate a tremendous amount of work that will not be achieved for the tools recommended in the DSM-5. The Manual makes no reference to these problems. The validity in uncontrolled conditions of psychometric tools posted on the Internet has to be studied. The equivalence of administering an online version of rating scales or personality tests was assessed in several papers with contradictory results. These results need to be confirmed in the general population and in representative clinical samples. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Le trouble de l’identité de genre (TIG), tel que défini par le DSM, est utilisé couramment par les psychiatres français pour la prise en charge des personnes trans dans les équipes hospitalières spécialisées. L’objectif de l’article est d’interroger cette procédure diagnostique dans un contexte où le Trouble de l’identité de genre est objet de débats et de controverses et où la caractérisation pathologique de l’expérience transgenre est questionnée. Méthode À partir d’une enquête ethnographique de terrain, effectuée entre 2005 et 2008 auprès d’une équipe hospitalière spécialisée, l’article se centre sur l’usage du Trouble de l’identité de genre dans la consultation psychiatrique en essayant de saisir ce qu’il impose et propose à toutes les personnes concernées, médecins et consultants, et ce qu’il laisse percevoir de notre conception de l’identité sexuée. Pour ce faire, il est proposé en premier lieu de ne pas retenir le terme d’autodiagnostic, mais de s’en tenir à ce qui est présenté par les consultants au plus près de ce qui est dit. Résultats Trois modalités de déclarations ont ainsi pu être dégagées : des déclarations d’identité , des déclarations de situation et des déclarations d’intention . L’article montre quelles mises à l’épreuve elles subissent au cours de l’investigation psychiatrique. Discussion Dans ce processus diagnostique de Trouble de l’identité de genre, l’identité sexuée est bien pensée comme subjective (le fait d’un sujet) mais dans une version de l’intériorité mentale, ce qui est assez bien en phase avec la version occidentale classique de l’identité sexuée où le genre est conçu comme une propriété des personnes. Conclusion Cette manière de prendre en charge les choses n’est pas toujours aussi productive que les psychiatres l’imaginent. Si la plupart tiennent fermement au diagnostic et à sa validité, c’est parce qu’ils le voient comme le seul moyen de ne pas se fourvoyer dans une transition inappropriée. Pourtant, il n’est pas sûr que ce soit le diagnostic qui protège les différents protagonistes de ce risque comme le suggère la conclusion de l’article. Objectives The gender identity disorder (GID), such as defined by the DSM, is usually used by French psychiatrists to take care of trans people in specialized hospital teams. The paper questions this diagnostic process in a context where the GID is object of debates and controversies and where the pathological characterization of the transgender experience is questioned. Methods From an ethnographic fieldwork conducted between 2005 and 2008 in a French hospital, the paper focuses on the use of GID in the psychiatric consultation, trying to show what it imposes and proposes both to doctors and consultants. First of all, it is suggested that the term autodiagnosis should not be used to define consultants’ discourse but to hold on to what they said precisely in the first consultation. Results Three modes of declaration have been found: declarations of identity, declarations of situation and declarations of intent. This paper shows how they are put to test in the psychiatric investigation. Discussion In this diagnosis process, the gender identity is seen as subjective but in a version of mental interiority in conformity with the classic western version of gender identity that sees gender as a property of the person. Conclusion This way of taking care is not as productive as psychiatrists imagine it is. If most of them are attached to the diagnosis of GID, it is because they see it as the only way to protect against an inappropriate transitioning. Nevertheless, it is not sure whether it is the diagnosis, which can do this as the conclusion of this paper suggests. [ABSTRACT FROM AUTHOR]

Résumé La remédiation cognitive (RC) est une nouvelle approche thérapeutique dont le postulat repose sur l’hypothèse de la plasticité cérébrale permettant ainsi à des sujets présentant des défaillances cognitives spécifiques d’améliorer leurs fonctions exécutives ainsi que leur qualité de vie. Des programmes ont été appliqués et validés chez des adultes présentant un trouble schizophrénique et sont à l’origine du développement de programmes dédiés aux enfants présentant divers troubles psychiatriques pour lesquels des dysfonctionnements exécutifs ont été repérés. C’est le cas des enfants présentant un trouble du spectre autistique, un trouble déficit de l’attention/hyperactivité (TDA/H) ou encore une anorexie mentale. Le centre hospitalier Sainte-Anne qui a créé un centre de référence de remédiation et de réhabilitation psychosociale (C3RP) a développé, en parallèle de prises en charge destinées aux adultes, des programmes destinés aux enfants présentant des troubles du développement. Inspirés de programmes validés, français et anglo-saxons, la méthode associe des tâches papier-crayon et des jeux de société pour optimiser les fonctions d’attention, de mémorisation, de planification et de flexibilité mentale chez des enfants présentant un TDA/H ou des troubles des apprentissages. Ce programme, mené en parallèle de programmes classiques de prise en charge, témoigne dans une étude de faisabilité de sa bonne acceptation par l’enfant et sa famille ainsi que d’un impact positif sur les fonctions exécutives même si ce résultat demande à être répliqué. Summary The hypothesis of cerebral plasticity in psychiatric disorders has encouraged clinicians to develop cognitive remediation therapy (CRT), a new therapeutic approach based on attention, memory, planning, and mental flexibility tasks. The first cognitive remediation programs were developed and validated for adults with schizophrenia and were shown to have a positive impact on executive functions as well as on quality of life. In children and adolescents, researchers emphasized the existence of executive dysfunction in neurodevelopmental disorders such as autistic spectrum disorder, attention deficit disorder, and eating disorders. For these disorders, neuropsychological studies suggest that memory, planning, attention and mental flexibility are impaired. Despite the paucity of studies on cognitive remediation (CR) in children, preliminary results have suggested, as in adults with schizophrenia, good compliance and optimization of executive functioning. Consequently, programs dedicated to young subjects were developed in English-speaking countries, and the Department of Child and Adolescent Psychiatry of Sainte Anne Hospital (Paris) developed a new CR program for children with attention deficit disorder, academic problems, or eating disorders. These programs complete the field of CRT proposed by Sainte Anne Hospital's Remediation and Psychosocial Rehabilitation Reference Center, initially designed for adults with schizophrenia. Our team used and adapted validated tools such as Delahunty and Wykes's CRT program (translated and validated in French by Amado and Franck) and Lindvall and Lask's CRT Resource Pack. One program was developed for an adolescent with anorexia nervosa and applied to the subject and her family, but the purpose of this paper is to present a CR approach for children with attention deficit disorder or academic disorder, a 6-month program based on paper-pencil tasks and board and card games. The team was trained in different kinds of cognitive remediation, and the program was applied by a clinical nurse with the supervision of a child and adolescent psychiatrist and the department's neuropsychologists. Paper-pencil tasks were adapted from the CRT program for adults; the card and board games used were geometric figures, illusions, Rush Hour ® , Set ® , Jungle Speed ® , Color Addict ® , etc. These games are available in stores and the program can be applied at home, which helps families set aside their preoccupations with their child's academic performance. Diagnostic and neuropsychological evaluations were done before the beginning of the therapy and repeated at the end of the 6-month program. This program does not ignore the metapsychological impact of the therapy, and work on self-esteem is also done. The presence of the therapist is necessary, which seems better than a computer program, which cannot encourage the young subject in the same personalized and empathetic way. We therefore conducted the first clinical feasibility trial of cognitive remediation in young subjects and present a clinical case of a 6-year-old boy with attention deficit disorder and academic disorder. The results of neuropsychological evaluations before and after therapy suggest improvement in executive functions and better self-esteem. Satisfaction for the boy and his family was high. Even if these results need to be replicated, cognitive remediation appears to be a new therapeutic tool, complementary to classical approaches used in childhood psychiatric disorders. The Department of Child and Adolescent Psychiatry will submit this program to a research program conducted by the National Health Department to study the impact of this approach in a controlled study. [ABSTRACT FROM AUTHOR]

Résumé Après l’urgence chirurgicale du traumatisme physique vient le temps de la reconstruction faciale, physique, mais aussi psychique, moins visible et parfois bien plus complexe. L’auteur se base sur le travail clinique d’un atelier thérapeutique autour du portrait, plus précisément en se référant à deux séquences cliniques de ce groupe pour examiner les liens étroits entre la création et la restauration de l’image de soi. Cette étude monocentrique a été menée dans une unité de chirurgie réparatrice à Amman (Jordanie), avec près de 200 victimes civiles de la guerre civile en Irak sur une durée de six mois. Ce travail sur le terrain permet de mettre à jour la diversité des mécanismes et des étapes par lesquelles passent les mutilés de guerre afin de se reconstruire une identité. À travers l’atelier portrait apparaît la symbolisation de la phase dépressive qui précède la reconstruction identitaire. Reconstruction comes after the surgical intervention for a physical trauma. The rebuilding of the face involves psychological as well as physical processes. The psychological aspect of reconstruction is less visible but more complex. The findings of therapeutic workshops based on the concept of “the face” have been invaluable. Clinically, the workshops referred specifically to an examination of the links between the creation of and restoration of self-image. This six-month long, mono-centric study took place in a surgical ward in Amman (Jordan) which treated almost 200 civilian casualties of the Iraqi civil war. The results improve our knowledge of the diversity of the mechanisms and stages that the casualties experienced to rebuild their identity. The first stage was to ask the patients to draw a self-portrait. All the patients portrayed themselves before their trauma. Then they were then asked to draw themselves as they were “now”, ie: after the trauma. Dira, a young burns patient, looked at himself in a mirror for the first time since the accident. For his second self-portrait he chose a variety of different papers and materials to portray the scars and the different textures of his skin. Another child used stickers to portray himself like a mosaic. Most of the patients started their work with a pencil paper and drew an oval. This portrayed the “real face”, the one hidden under the scars, the burnt skin, the bandages… Hidden, like in Dira's self-portrait, under the different layers of paper. By hiding his original face, which was still there but unattainable, he portrayed his loss and fragility. It can be seen from this workshop that the whole body image is modified after physical trauma. The intensity of the care, the pain, and the bandages is an emotional investment. They become a type of protection but also an obstacle to the process of restoring the body image. The perception of one's body as “damaged” causes a serious imbalance of the patient's self-image because of the emotional association with a deep feeling of fragility. In turn, this sense of physical fragility is closely connected to its mental equivalent. The patient's spirit goes through a destructive phase because of the external and internal emotional overload. This mechanism, which drives the body image, can slow down mental development when the patient is a child or a teenager. This destructive stage of recovery precedes the reconstruction of the patient's identity. The therapeutic workshop illustrates the symbolic importance of this stage by exposing the link between the wish to gather together the fragmented body image post-trauma and the cutting-out that Dira did for his post-trauma self-portrait. The patient rebuilds his self-image by gathering it together piece by piece. Therapeutic workshops and individual therapy enables patients to verbalize their anxieties. Therapy helps them to overcome their fear of the physical reality of their trauma and to reconstruct their psychological identity simultaneous to the surgical reconstruction. [ABSTRACT FROM AUTHOR]

Résumé Objectifs L’intention de cet article est discuter le rapport entre perception et conscience, et de montrer l’intérêt de séparer ces deux notions. Méthode L’article exploite une série d’observations cliniques et de résultats expérimentaux, puis examine la manière dont la littérature moderne traite du rapport entre perception et conscience. Résultats Depuis plus d’un siècle, les sciences modernes (psychologie, psychologie expérimentale, neuropsychologie) ont prouvé qu’il existe chez l’homme une capacité à appréhender le monde extérieur en marge, et sans doute en avance, de toute conscience. Ainsi peut-on se référer, par ordre chronologique, aux travaux menés dès la fin du xix e siècle sur des sujets hystériques, aux expériences tachiscopiques à partir des années 1920, puis à l’étude du blindsight depuis les années 1970. Confrontée à ces faits, la littérature moderne a dû adopter progressivement la notion de perception inconsciente. Pourtant, et paradoxalement, elle n’a pas renoncé à l’usage classique définissant la perception comme un phénomène conscient. Discussion Tous ces travaux confirment en réalité l’ancienne conception de Leibniz, qui soutenait déjà l’existence de perceptions insensibles. Leibniz s’opposait alors au discours de Descartes pour qui rien de la vie d’âme ne peut échapper à la conscience et, par là même, il introduisait la possibilité d’une vie psychique inconsciente. Leibniz reste pourtant un auteur du passé et la surprise que suscitent encore ces différents phénomènes est à la mesure de l’oubli dans lequel est tombée sa pensée, alors que l’influence de Descartes reste intacte. Il existe encore ainsi un roc de cartésianisme qui sous-tend toujours notre pensée moderne et continue de défier notre croyance dans l’inconscient. En utilisant toujours la définition classique de la perception, la science nie en quelque sorte les manifestations inconscientes qu’elle continue d’étudier. Conclusion Il apparaît possible, et nécessaire, de se dégager de ce paradoxe en reconnaissant la nature fondamentalement inconsciente de la perception et, logiquement, la séparation stricte entre perception et conscience. Nous proposons une définition nouvelle de la perception, de référence leibnizienne : la perception est la réception au niveau des organes sensoriels d’un stimulus extérieur et la traduction immédiate de ce stimulus en un matériel psychique de nature inconsciente. Purposes This paper aims to discuss the relationship between perception and consciousness, and to show the interest of separating these two notions. Method The paper uses a series of clinical observations and experimental results, and then examines the way modern works deal with the relationship between perception and consciousness. Results For over a century, modern science (psychology, experimental psychology, neuropsychology) has proved that humans have the ability to apprehend the external world apart from, and certainly before, any consciousness. Chronologically, we can effectively refer to works on hysterical subjects in the late 19th century, tachistoscopic presentations from the 1920s, and blindsight studies from the 1970s. Facing these facts, modern works needed to gradually adopt the notion of unconscious perception. Paradoxically however, they have not relinquished the traditional practice of defining perception as a conscious phenomenon. Discussion In fact, these works corroborate the old view of Leibniz, who had already affirmed the existence of insensitive perceptions. Opposed to Descartes, who thought that nothing in mental life escapes consciousness, Leibniz introduced the possibility of an unconscious life. Although Leibniz belongs obviously to the past and the surprise generated by these different phenomena corresponds to a general oversight of his thinking, whereas Descartes’ theory remains intact. A Cartesian rock remains that underlies our modern thinking and defies our conviction in the unconscious. Still using the traditional definition of perception, science somehow denies the manifestations of the unconscious and continues to study them. Conclusion It seems possible, and necessary, to free ourselves from this paradox, admitting the inherently unconscious nature of perception and, logically, the strict separation between perception and consciousness. We conclude with a new definition, referring to Leibniz, of what is perception: the reception of an external stimulus by sensory organs and the direct translation of this stimulus into a mental material, which is by nature unconscious. [ABSTRACT FROM AUTHOR]

Résumé L’objectif de cet article est d’exposer les caractéristiques anatomo-cliniques et histologiques des différentes gastropathies toxiques, médicamenteuses et vasculaires auxquelles peut être confronté le pathologiste lors de l’analyse de biopsies gastriques. Nous aborderons dans cet article différents types de gastropathies médicamenteuses (les gastropathies réactionnelles, induites par les inhibiteurs de la pompe à protons, par les thérapies ferriques, par les résines échangeuses d’ions, par la colchicine, par les taxanes, par l’acide mycopyhénolique, après radio-embolisation et chimio-embolisation), la gastropathie radique, la calcinose gastrique et les gastropathies vasculaires (ectasie vasculaire gastrique antrale et gastropathie d’hypertension portale). Summary The aim of this paper is to describe the clinicopathological features of toxic, medicamentous and vascular gastropathies, the pathologists can sometimes have to deal with during the micoscopic examination of gastric biopsies. We describe in this paper various drug-induced gastropathies (reactive gastropathy, proton-pump inhibitor gastropathy, iron medication induced gastropathy, sodium polystyrene gastropathy, colchicin gastropathy, taxans gastropathy, Yttrium 90 microspheres induced gastropathy, mycophenolic acid gastropathy, radioembolisation and chimioembolisation induced gastropathy), radiation-induced gastropathy, gastric calcinosis, and vascular gastropathies (gastric antral vascular ectasia and portal hypertensive gastropathy). [ABSTRACT FROM AUTHOR]

Résumé Chez l’enfant à risque de crises d’épilepsie prolongées, le traitement exige une administration rapide de benzodiazépines par un accompagnant ou un proche formé à l’administration du médicament. Chez les enfants considérés à risque de convulsions prolongées, la possibilité d’une évolution vers un état de mal augmente à partir de la 5 e minute. Le traitement de ces crises au moment où elles surviennent permet souvent d’éviter une telle évolution et peut contribuer à éviter des interventions d’ambulances et des hospitalisations inutiles, tout en facilitant l’intégration scolaire de l’enfant. L’étude PERFECT™ a été mise en place en 2011 afin d’établir un état des lieux des pratiques réelles d’administration des médicaments de secours en cas de crise d’épilepsie prolongée à travers l’Europe, en dehors du milieu hospitalier et plus particulièrement dans les écoles. Les conclusions initiales de cette étude en France sont qu’il existe un défaut de recommandations claires pour la prise en charge des enfants souffrant de crises prolongées d’épilepsie en dehors du milieu hospitalier. Les principaux obstacles à une prise en charge appropriée sont un manque d’informations et de connaissance, une formation inadéquate des accompagnants qui encadrent l’enfant, en particulier des enseignants, sur les crises prolongées et leur prise en charge et un manque de recommandations et de cadres juridiques clairs et cohérents pour orienter les pratiques. Pour qu’une prise en charge médicamenteuse des crises épileptiques prolongées soit systématique, une action concertée devra être mise en place entre les secteurs de la santé et de l’enseignement pour combler ces lacunes. Toutes les parties concernées devront également reconnaître qu’il s’agit là d’une étape cruciale pour favoriser l’intégration sociale de la catégorie vulnérable des enfants atteints d’épilepsie. Summary Context and objectives Guidelines recommend that any epileptic seizure that lasts more than 5 min (prolonged seizures) be treated immediately with benzodiazepines in order to prevent progression to status epilepticus. However, there is very little published information on how such seizures are managed outside of the hospital setting, for example in schools or at home. This paper presents the initial results, specific to France, of the Practices in Emergency and Rescue medication For Epilepsy managed with Community-administered Therapy (PERFECT™) Initiative, which was set up in 2011 to gain a better understanding of how prolonged convulsive seizures are managed and rescue medication is administered in out-of-hospital settings across Europe. Methods The PERFECT Initiative was conducted in six countries (France, Germany, Italy, Spain, Sweden, the United Kingdom) and consists of three phases. This paper reports on the first two phases of this study and focuses on findings for France. Phase I of the PERFECT initiative consisted of a review of existing clinical guidelines, guidance to schools, and relevant policy and legal frameworks in France, from both published and web-based sources. Phase II consisted in a telephone survey of 20 pediatricians, pediatric neurologists, and neurologists who treat children with prolonged convulsive seizures in France in order to obtain their views on how prolonged seizures are managed outside of hospitals. Phase III is ongoing and consists of a survey of children with prolonged seizures and their caregivers. Results Existing clinical guidelines pertain mainly to the hospital setting and contain very little informations on how prolonged seizures should be managed outside the hospital. Guidance to schools is unclear as to whether teachers are allowed to administer rescue medication to children and legal frameworks are full of contradictions. As a result, whether or not children who experience prolonged seizures receive their rescue medication during school hours depends mostly on the resources and training available in each school. Healthcare professionals stated that lack of information on prolonged seizures and their management, as well as a lack of up-to-date guidance specific to schools were considerable obstacles to a systematic approach to managing prolonged seizures outside of the hospital. Discussion In France and elsewhere, there has been growing recognition of substantial gaps in the provision of care to children with epilepsy in recent years. However, the issues that arise for children who require rescue medication for prolonged seizures outside of hospitals are conspicuously absent from policy documents or clinical guidelines. This lack of information, combined with insufficient training in schools on epilepsy, and inadequate guidelines create a situation in which schools are likely to call an ambulance every time a child has a prolonged seizure, therefore risking delays in treatment, and putting the child at risk of status epilepticus and clinical sequelae, not to mention stigmatization at school. Conclusion There is a need for more explicit guidance covering educational and healthcare settings, clearer information to parents and schools, and more systematic training to be made available to caregivers in order to ensure that all children at risk of prolonged seizures receive their prescribed rescue medication as quickly as possible, regardless of where their seizure occurs. [ABSTRACT FROM AUTHOR]

Résumé Nous assistons actuellement à une inflation du nombre de journaux scientifiques et du nombre d’articles publiés dans des revues indexées. En pratique, 60 % des articles sont cités moins de 2 fois et donc probablement jamais lus. Sachant que les financements des auteurs scientifiques dépendent de leurs publications, tout les encourage à publier, et ce quelle que soit la portée de leurs résultats. On observe par conséquent l’émergence de techniques visant à amplifier artificiellement le nombre et l’impact des articles publiés. Cet article détaille quelques-unes de ces techniques : le perroquettage , le saucissonnage , le marketing, les co-auteurs « stars » fantômes, la mise en ligne précoce des articles acceptés, l’organisation en cartels, la multiplication des revues de littérature, et la disparition progressive des cas cliniques. Dans le paysage de la recherche biomédicale, la psychiatrie se situe extrêmement bien par rapport aux autres disciplines médicales. En effet, plusieurs revues en psychiatrie et en neurosciences possèdent des facteurs d’impact parmi les plus élevés des revues médicales. Malheureusement, la psychiatrie n’échappe évidemment pas aux dérives décrites précédemment. Des pistes sont proposées dans cet article pour pouvoir sortir de cette impasse et bénéficier d’une évaluation rénovée de la qualité scientifique. Enfin, la question des sciences humaines est également discutée en lien avec les processus de publication actuels. We’re currently witnessing an inflation of the number of scientific journals and of papers published in indexed journals. Indeed, 60 % of papers are cited less than twice and so probably are never read. Because the financing of scientific authors is based on their publications, everything encourages them to publish always more, and this regardless of the significance of their results. So emerging techniques to artificially boost the number and the impact of papers appear. We detailed here some of these key techniques: self plagiarism, salami slicing, marketing, famous ghost co-author, early online preview of accepted articles, cartels organization, proliferation of literature reviews, and gradual disappearance of clinical reports. Mapping the landscape of the biomedical research, psychiatry is extremely well-positioned compared to other medical disciplines. Indeed, many journals in psychiatry and neurosciences have impact factors among the highest of medical journals. Unfortunately, psychiatry is not immune to the drifts developed above. Ideas are proposed in this article to get out of this impasse and benefit from a renewed scientific quality assessment. Finally, the question of the humanities is also discussed in relation to the existing publication process. [ABSTRACT FROM AUTHOR]

Résumé Le thème de la santé mentale a considérablement élargi le champ d’intervention de la psychiatrie et de la psychologie, en invitant ces disciplines à considérer non seulement la maladie mais, dans l’accomplissement personnel, l’accès au bien-être. Cette vision de la santé a fortement essaimé au cours des années 1960, notamment dans l’antipsychiatrie. Il n’y est donc pas seulement question d’une perspective thérapeutique mais bien d’une véritable philosophie politique et morale dont on peut tenter de retracer les origines et les fondements. À ce titre, l’article, revenant sur les écrits fondateurs de William James, cherche d’abord à montrer combien la notion de santé mentale est indubitablement liée aux principes d’une psychologie du soi. Partant de ce premier éclairage, il entend ensuite indiquer de quelle manière cette pensée a cherché à mêler un parti épistémologique et méthodologique au projet d’une clinique susceptible d’aiguiller le changement social. Psychology and psychiatry have significantly extended their scope of action by addressing the topic of mental health and by focusing, beyond the study of disabilities, on well-being through personal development. This approach was already widely popular in the 1960's, especially in the field of anti-psychiatry. As a result, mental health, as a therapeutic perspective, went on to become a major concern for moral and political philosophy. This paper aims to trace back the origins of this shift and delineate its foundations. To this end, the pioneering work of William James serves as a basis for showing how the notion of mental health relates to the tenets of the psychology of the self. Then, this paper uses this analysis to demonstrate how this approach combined epistemological and methodological principles to support a new clinical project that was supposed to contribute to social change. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The objectives of this study are to offer some clinical and semiological considerations for a psychopathological conception of psychopathy. In the first part, the author provides a history of this diagnosis (see Introduction of this paper) and a description of the current trends in the international literature: the contributions of R.D. Hare and the PCL-R, D.J. Cooke and the Comprehensive Assessment of Psychopathic Personality (CAPP) and T.H. Pham for French-speaking validations (subtitle 2 of this paper). After that, the author proposes a definition of psychopathology in the sense of Minkowski and Jaspers proposals (i.e. these latter come from the principles of the continental phenomenology) (subtitle 3 of this paper). Patients and methods: This theoretical essay is improved by clinical situations. The psychopaths were interviewed in prison or in forensic centers. The method used was a psychopathological analysis from the clinical material, as well as references to the phenomenological psychopathology (continental phenomenology) and the philosophy of J.-P. Sartre, M. Foucault and P. Ricœur. Results: This study shows that it is useful to consider a psychopathological reflection on psychopathy and this approach gives a framework for the clinical investigations. Regarding that, the author proposes a first comparison between the binswangerian conception of mania and the psychopathic functioning (subtitle 4 of this paper). By this way, we can understand why many studies show a positive correlation between the scoring in the PCL-R and the scale of the MMPI mania. The behavior is similar but the difference is about the dialectic between the “ego” and the “alter ego”. The maniac has a fundamental crisis of the “ego”, which the psychopath does not have. A second finding of our investigations concerns emotions and the dimension of the adaptive psychopathic disorder (subtitle 5 of this paper). An epistemological discussion of the concept of emotions allows us to say that the psychopath is competent in the management of emotional stimuli, which confers a psychological advantage to him. In addition, fundamental research on the management of the emotional stimuli in the psychopath seems to confirm our hypothesis of an adaptive dimension for the psychopathic disorder. The last point we discuss is about “morality” and “ethics” for the psychopath (these notions are from the concepts of empathy and sympathy). On the basis of Foucault''s distinction between these two concepts, it becomes possible to study these dimensions and integrate them in the practice of psychopathology. This proposal enables to introduce the concept of narrativity. This observation prompts the clinician to listen to the patient and to pay attention to how he has to tell himself. Conclusions: Our contribution shows that it is possible to conduct a study about the psychopathology of psychopathy. Our study is not intended to be complete and irrefutable. Our goal is rather to give some evidence for a psychopathological consideration on psychopathy (as indicated by the title of this paper). Finally, we offered some thoughts on the practice of psychotherapy by integrating the adaptive dimension of this disorder which, when it is missed, can lead to a psychotherapeutic stalemate. [Copyright &y& Elsevier]

Abstract: Objectives: The objectives of this study are to offer some clinical and semiological considerations for a psychopathological conception of psychopathy. In the first part, the author provides a history of this diagnosis (see Introduction of this paper) and a description of the current trends in the international literature: the contributions of R.D. Hare and the PCL-R, D.J. Cooke and the Comprehensive Assessment of Psychopathic Personality (CAPP) and T.H. Pham for French-speaking validations (subtitle 2 of this paper). After that, the author proposes a definition of psychopathology in the sense of Minkowski and Jaspers proposals (i.e. these latter come from the principles of the continental phenomenology) (subtitle 3 of this paper). Patients and methods: This theoretical essay is improved by clinical situations. The psychopaths were interviewed in prison or in forensic centers. The method used was a psychopathological analysis from the clinical material, as well as references to the phenomenological psychopathology (continental phenomenology) and the philosophy of J.-P. Sartre, M. Foucault and P. Ricœur. Results: This study shows that it is useful to consider a psychopathological reflection on psychopathy and this approach gives a framework for the clinical investigations. Regarding that, the author proposes a first comparison between the binswangerian conception of mania and the psychopathic functioning (subtitle 4 of this paper). By this way, we can understand why many studies show a positive correlation between the scoring in the PCL-R and the scale of the MMPI mania. The behavior is similar but the difference is about the dialectic between the “ego” and the “alter ego”. The maniac has a fundamental crisis of the “ego”, which the psychopath does not have. A second finding of our investigations concerns emotions and the dimension of the adaptive psychopathic disorder (subtitle 5 of this paper). An epistemological discussion of the concept of emotions allows us to say that the psychopath is competent in the management of emotional stimuli, which confers a psychological advantage to him. In addition, fundamental research on the management of the emotional stimuli in the psychopath seems to confirm our hypothesis of an adaptive dimension for the psychopathic disorder. The last point we discuss is about “morality” and “ethics” for the psychopath (these notions are from the concepts of empathy and sympathy). On the basis of Foucault''s distinction between these two concepts, it becomes possible to study these dimensions and integrate them in the practice of psychopathology. This proposal enables to introduce the concept of narrativity. This observation prompts the clinician to listen to the patient and to pay attention to how he has to tell himself. Conclusions: Our contribution shows that it is possible to conduct a study about the psychopathology of psychopathy. Our study is not intended to be complete and irrefutable. Our goal is rather to give some evidence for a psychopathological consideration on psychopathy (as indicated by the title of this paper). Finally, we offered some thoughts on the practice of psychotherapy by integrating the adaptive dimension of this disorder which, when it is missed, can lead to a psychotherapeutic stalemate. [Copyright &y& Elsevier]

Abstract: Objective: Mindfulness-based cognitive interventions are increasingly making their way into the field of healthcare on account of proven effects in a wide range of mental disorders. Despite the psychological aspect emphazised in the etiology of sexual disorders, they paradoxically have been less investigated in terms of sexual problem management. The objective of this paper will be to highlight through the review of studies relating to the integration of mindfulness in sexotherapeutic programs the applicability potential of these approaches and, more particularly, to examine the specific relevance of Mindfulness-Based Cognitive Therapy (MBCT). Method: To show the interest of mindfulness for sexual problems, which is the major component of the MBCT intervention, we have first reviewed the underlying psychological causes of sexual dysfunctions through the DSM-4TR criteria and the main international search engines Interscience Wiley, PsycARTICLES, PubMed, Science Direct and Springerlink. Moreover, this bibliographic review has enabled us to select the studies relating to the use of mindfulness in the field of sexology. Results: This research has enabled to show four main types of etiological factors of psychological type, namely cognitive, emotional, behavioural and environmental factors. The scientific literature points out more specifically the key role of cognitive parameters in sexuality, especially through the influence of negative automatic thoughts and distractions, and of relational parameters such as a bad communication in the couple. Furthermore, it reveals a paucity of empirical studies and two main orientations targeted respectively on the relevance of mindfulness to sexual or relational problems, as well as, to our knowledge, no study about MBCT in that research field. Discussion: Considering the action process of the multimodal MBCT program detailed in this paper, the highlighting of the obvious link between cognitive factors and sexual dysfunctions and the promising results of the studies integrating mindfulness in sexotherapeutic treatment, this new kind of approach seems to be of great interest for the management of sexual dysfunctions and, more specifically, through the relapse prevention which is a fundamental aspect of any sexual therapy. [Copyright &y& Elsevier]