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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: Objective: Fight against discrimination and stigmatization of people living with mental health disorder has become one of the most important political public health objectives. It has been identified as one of the five priorities of the 2008 European Pact for Mental Health and Well-Being. Stigmatization impacts the quality of life and jeopardizes the social integration. It has been shown that compliance to medical care was also impacted by individuals’ perception of their stigmatization. Numerous international programs targeting general population have been elaborated since the last decades, but those communication strategies haven’t raised the interests of researchers and academics. Hence, very few data are available to set new objectives to lower the social impact of stigmatization in people living with mental health condition. Material and methods: This paper examines the rational and effectiveness of different anti-stigma campaign targeting mental health. By reviewing the scientific literature and policy documents on different strategies to address and lower stigmatization, we identified a typology of stigma-orientated actions and policies. Communication campaigns are the most common instrument used to address stigmatization. They are sometimes associated with communication programs targeting representations in general population through campaigns as well as representations in subgroups, through local and/or national actions. Specific information and training for journalists have also been experienced. Results: Very few researches have observed convincing effects of anti-stigma campaigns in general population. Evaluations of the communication campaigns have revealed that they had a limited impact on representations. Attitudes towards people living with a mental disorder were still negative 5 years after the Changing Mind campaign, although there was an impact on the perceived distance by the respondents (how people living with mental health condition feel different from us). Actions targeting media and journalists led to ambivalent results, with a rise of positively connoted journal articles as well as negatively connoted papers. Conclusions: Campaigns targeting general objectives have not been proven to be effective. Some authors state that they should be replaced by local actions and programs, orientated to specific subgroups and should (a) associate the psychiatric services users and their families, (b) empower people living with mental health conditions, (c) be developed upon the experience of people who are been stigmatized. The rational of past communication campaigns as well as global communication programs were impaired by the absence of an operational definition of the problem addressed (discrimination, stigma, and stigmatization). Lack of empirical data on stigmatization jeopardizes the effects of these campaigns and their potential development. Conflict of interests in people managing the campaigns and the absence of systematic evaluation are also pointed as limitation for future developments. [Copyright &y& Elsevier]

Abstract: Professionals working in a service for young people with gender identity disorder (GID) often experience a particular type of pressure in the course of the work, which makes thinking and decision-making very difficult. The paper suggests that an examination of the position of the professional and of its service within the system may bring some relief and be a starting point to direct thinking and possibly action. The perceived position of the professional and of the Gender Identity Development Service within the wider organisation of a psychotherapy and mental health trust is discussed. The paper makes reference to the model developed by Lagenhove and Harré as described by Campbell and Groenbaek in their book Taking positions in the organisation. The position taken by the professional or the service is also explored as a possible re-enactment of the psychological dynamics of the young people with GID and their families. This view is based on Britton''s paper on the mirroring and re-enactment of individual and family dynamics in the professional network. A view is put forward that this dynamic leads the professional or the service to the risky position of “working at the edge”. The paper discusses processes that could facilitate the move from a position of being psychologically at an edge to the more secure position of being in the mainland. These involve exploration of the model of care and the relationship of the professional to the wider organisation in which the service is located and to self help organisations. [Copyright &y& Elsevier]

Abstract: Under the Belgian Social Defence Law (1964), mentally disordered offenders who are deemed to lack criminal responsibility have to be interned in an ‘Institution of Social Defence’ rather than in a prison. There, they are supposed to receive specialised treatment before their rehabilitation and re-insertion into the community. This paper discusses expertise practice in relation to the Social Defence Law. The paper first gives a description of the requirements of the law. The paper then presents the prevalence of clinical syndromes (axis 1) and of personality disorders (axis 2) among a sample of internees (N =98). The sample presents a high co-morbidity (2.6) of axis I syndromes, and of axis 2 personality disorders (1.7), the majority of them (64%) present both axis diagnoses. The paper also discusses the prevalence of a high psychopathy as measured by the PCL-R among internees (5-8%) as compared to prison inmates given the aim of the law of protecting the society against dangerous individuals. The paper shows that the Social Defence Law embraces a very large spectrum of psychiatric diagnoses including personality disorders and psychopathy. The following recommendations could improve expertise practices: (a) the consideration of earlier propositions relating to the improvement of the Social Defence Law; (b) a comparative research between psychiatric diagnoses of internees and of inmates; (c) a better definition of clinical criteria relating to the application of the law; (d) the implementation of a specialised observation unit before the decision to intern; (e) the need to go beyond a dichotomous conception of the ability to control; (f) the consideration of contextual factor of dangerousness; (g) encouraging the use of validated risk and clinical assessment instruments; (h) a better financing for expert work. [Copyright &y& Elsevier]

Résumé Le terme « capital social » est un concept à la fois géographique, politique, économique et sociologique, basé sur le principe d’un réseau de relations interpersonnelles. L’association entre capital social et santé mentale est étudiée en tant que facteur modulateur/explicatif de différence et de variation des états de santé des personnes d’un groupe, ainsi que pour son impact sur la prévention, le développement et le procès psychosocial de rétablissement. Le capital social semble jouer un rôle particulièrement important dans l’intégration des immigrants, qui présentent, à leur tour, une vulnérabilité accrue à la maladie mentale liée à des facteurs de stress psychosociaux. Dans cet article nous allons discuter de l’utilisation de ce concept dans l’étude des facteurs environnementaux de maladie mentale et, notamment, de la nécessité d’adaptation de ses indicateurs en fonction du contexte et des populations étudiées. The concept of social capital is useful to study the impact of the interpersonal relationships/networks on the development, outcome, prevention and recovery of mental disorders. Among migrant populations, it seems to play a protective role in mental health, associated to better social support, resilience and less exposure to discrimination. In this paper, we will present the current data on this subject. Then we will discuss the use of this concept in the study of environmental risk factors of mental disorders and the need to construct contextual indicators, especially in minority groups. [ABSTRACT FROM AUTHOR]

Abstract: In this paper, we tried to show through some clinical examples that there is not on the one side the body, and on the other the psyche. The Assisted Reproductive Technology (ART), because the field it covers, namely procreation, is a magnificent observatory of interactions between body and psyche, desire and inhibition, request and mental block, hatred and love… Assisted reproduction techniques are often indicative of links between these terms, and of what symbols are at stake in the couples concerned. It is interesting to see how these sophisticated techniques not only work as a solution to infertility problems – which are plural and diverse – but as a developer of human problems that we previously thought we would escape. [Copyright &y& Elsevier]

Abstract: The children and particularly the adolescents are acknowledged as major customers and early adopters of the Internet that has become their major source of information about a wide range of topics. The Web offers a convenient and anonymous route to information, services, and products that formerly required contact with healthcare providers. But the Internet could be dangerous with the antihealth sites like prosuicide or proanorexia that developed and maintained by people with these disorders. This paper is a review of the recent literature on the risks and the advantages that can result in the use of the Internet in mental health. The Web use facilitates obesity, sleep disorder and academic failure. It could decrease quality of life. The Internet addiction has become an important issue of mental health for college students. Furthermore, the Internet contains an extraordinary amount of information on the recreational use of psychoactive substances. The impact of the online pornography is too less estimated. A lot of sites make the apology of the suicidal acts or the anorexia nervosa. Far thinking to demonize this technical tool of communication, we detail the growing interest of the Web when it''s used as medical database or as therapeutic tool. The Internet is a major source of information for the general public in the field of health and particularly in the field of mental health. The quality and provenance of information and services like e-therapy offered to users through this medium are a source of concern to the healthcare community. Finally, the Internet is a technical progress involving new subjects and even new methods of research like the web-based survey or the googling studies. [Copyright &y& Elsevier]

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Abstract: Lacan has left a teaching, mainly in his “seminars”, which is often synthesized, simplified and reduced to a simple explanatory theory, principally regarding psychotic process. Such a simplifying view can become a discriminatory, iatrogenic conception of the psychotic person and of the psychotherapeutic (or psychoanalytical) treatment. In the first part of this paper, the author tries to show that Lacan’s teaching was principally a transmission of the psychoanalysis itself, in different ways, as half-sayings, ambiguity, poetry and style, topology, mathems… Lacan passed himself on as a possibility of analytical opening, like in a cure. He does not generate a rational discourse, but he proposed several different theories as simple “vectors”. In the second part, the author puts some concepts as “Name of Father foreclosure”, “borromean knot” and “object a” into a political (within the psychoanalytical community) and historical context. If those items of Lacan’s teaching are diverted from their primal function of “vectors” and are considered as explanatory theories, then they lose their pertinence and can lead to a stigmatizing conception and to possibly iatrogenic attitudes in the treatment. That will be examined further. [Copyright &y& Elsevier]

Abstract: The Attention-Deficit and Hyperactivity Disorder is frequent and well known in childhood and in child psychiatry. However, this disorder is widely under-diagnosed in adults. There has been a greater interest in this disorder for several decades: Several studies have indicated a persistence of symptoms beyond childhood and adolescence in up to 66% of cases, which leads to a prevalence of 5% in the general population of adults. This disorder is diagnosed on clinical presentation. The diagnostic criteria in adults are facilitated if the first symptoms of this disorder are detected before the age of seven. The symptoms are similar to those observed in children, even thought attention deficits are more frequent than impulsiveness or psychomotor hyperactivity in this population. Very often, patients diagnose their disorder on their own via journals or Internet, and then they try to find a specialist. The DSM-IV and ICD-10 criteria for adults include several items typically found in children suffering from this disorder, and differentiate several subtypes. This paper tries to clarify the functioning of this disorder, with the objective of a better knowledge and treatment for patients who are seriously handicapped by their trouble. Whereas there is a gender ratio of 4:1 (males: females) in children, women are as much concerned as men in the adult forms. The daily life of patients suffering from hyperactivity is disturbed in nearly all fields, including work, relationships and leisure. The disorder can lead to severe consequences for patients and their environment, including loss of work, separations, accidents and chaotic lifestyles. Hyperactivity can be difficult to distinguish from some of the other psychiatric disorders - mostly borderline or dissocial behaviour -, such as bipolar or conduct disorders. However, it can also occur in co-morbidity of any one of these disorders, and this in up to 60% of the cases. Nevertheless, it is important to mention that this disorder is usually present before the onset of the other co-morbid disorders. Multiple etiological factors seem to be implicated in this disorder. Several studies have highlighted the possible contribution of perinatal, neurobiological, neuroanatomical, neuropsychological and genetic factors. The abnormality most explored is the imbalance between noradrenergic and dopaminergic systems. Similarly, genetic studies underline the aberrations found in the dopamine transporter gene and in the D2 and D4 receptor genes. For general practitioners, social workers, forensic institutions or courts, it is important to realise that these patients can beneficiate from an adequate and effective treatment. Pharmacological treatments are the same as the ones for children, they include méthylphénidate and atomoxetine but also antidepressants and antihypertonics. Beside pharmacotherapy, psycho-education can significantly improve symptoms and results in improving self-management of daily life difficulties. [Copyright &y& Elsevier]

Abstract: This paper was initially presented during the scientific workshop of the French society for child and adolescent psychiatry and allied professions (SFPEADA), devoted to psychomotricity and its current bonds with child and adolescent psychiatry (Paris, September 29, 2005). The authors are a child and adolescent psychiatrist, using daily psychoanalytical psychotherapies in a universitary public hospital and two psychomotricians, who work in a child and adolescent public department, in a private activity and in a specialized institute (therapeutic, educational and teaching institute or ITEP). They present here the results of their clinical practices, exchanges and thoughts about a complex and discussed subject, which touches in more than one way with the bases of our clinical and therapeutic practices with children and adolescents: how do we choose the differential indications between psychotherapies and psychomotor therapies? [Copyright &y& Elsevier]

Abstract: This paper consists in an attempt of synthesis in which the author, after a 35-year-long career, updates what stays the same and what changes in the field of adoption. In the changes, there are the scarcity of adoptable children who do not have special needs; in what is growing, there is the States will of control upon the process and the coming of adopted children which are “made-to-measure” for non-traditional families. What stays the same is the processes and selection criteria for candidates-parents; the psychological experience of the adopted child, who have to integrate the trauma of their life, reconstruct themselves with an acceptable history, lean their identity against their double settling and be welcome without excessive hopes. [Copyright &y& Elsevier]

Abstract: In opposition to a widespread belief in psychiatry, mental disorders per se, without alcohol or drug abuse, represent a risk for violence against others, including homicide, that is significantly higher than that of the general population. The present paper extensively reviews the scientific literature during the past 15 years and present their findings in a summary table. The contradictory results of the notorious McArthur study are also presented and critically discussed. Elevated risks of assaults are more closely associated with a subgroup of patients showing one or more of the following characteristics: a history of previous violence; non compliance with antipsychotic medication and follow-up; alcohol and/or illegal drug abuse; violent fantasies; acute psychotic symptoms; and cerebral damage. Although violence associated with mental disorders is significantly higher than that observed among the general population, the absolute number of assaults committed by patients is still low. Between 85 and 97% of violent offenders are not mentally ill. Certain aspects of the deinstitutionalization, such as lack of outpatient resources and a modification of the law reflecting more concerns for the rights of the patients might provoke health care interruptions. However, a clinical commitment relayed by legal interventions in case of danger generate significant reduction of the risks for violence. [Copyright &y& Elsevier]

Progress in knowledge about bipolar disorders, in their clinical, etiological and therapeutic aspects, led these last 20 years to increase the interest for the childhood and adolescence onset forms of these disorders, even if they are rare. In this way, numerous studies emphasized the difficulties encountered in making the diagnosis at this age, mainly because the heterogeneity of the clinical picture observed. In this paper, the authors present the results of a retrospective, descriptive, clinical study performed from 50 cases attended in the Razi hospital child and adolescent psychiatry department in Tunis between 1996 and 2001. Among the 470 adolescents hospitalized in the Razi hospital child and adolescent psychiatry department in Tunis between 1996 and 2001, 50 were diagnosed as having bipolar disorder according to the DSM-IV criteria. Their clinical records were analyzed by means of an epidemiological card drawn from the WASH-U-SADS. Twenty-eight girls and 22 boys were included in the study. The mean age of these subjects at their first hospitalization was 15.8 years; 30% were firstly hospitalized between the age of 14 and 15 years, 24% between the age of 18 and 19 years. The mean duration of their follow-up was 28 months (6–72 months). Forty-four percent of them had previously exhibited episodes of mild depressive manifestations, 16% undiagnosed major depressive disorder, and 14% (only girls) suicide attempts. Familial history of mental disorders was found in 40% of them: non affective psychoses in 18% of the cases, bipolar disorders in 16%, major depressive disorder in 4% and alcohol dependence in 2%. Ninety-four percent of the patients were diagnosed as having bipolar I disorder and 6% bipolar II disorder. The diagnoses at their first hospitalization were very heterogeneous: manic episode in 48% of the cases, major depressive episode with psychotic features in 30%, schizophreniform disorder in 14%, mixed episode in 4%, and adjustment disorder in 4%. The atypical diagnoses were found significantly more frequent in patients firstly hospitalized before the age of 16 years (P < 0.005). During the follow-up, 92 manic episodes were recorded. The analysis of the manic episode clinical features also showed that atypical manifestations (mixed episodes or with psychotic features) were significantly more frequent in the patients firstly hospitalized before the age of 16 years (P < 0.02). Concerning the therapeutic aspects, mood stabilizers were used from the first manic episode in 82% of the cases. The adjunction of an antipsychotic agent during the acute phase of the mood episodes was found relatively frequent, probably because of the frequency of the psychotic features observed during these episodes. These results confirm numerous data previously reported in comparable studies. More particularly, they agree with the recently evoked hypothesis of two separate phenotypes in juvenile bipolar disorders: the early onset forms, in the youngest people, are characterized by an onset usually depressive type and by the occurrence of mood episodes frequently atypical in their clinical and developing aspects; while the later onset forms look almost like the clinical picture usually observed in adulthood. These data also show that it is essential to assess carefully the mood condition in children and adolescents exhibiting atypical pathological episodes. [Copyright &y& Elsevier]

Abstract: The following paper aims at finding and analyzing the objective conditions and the subjective processes which lead people to choose studying psychiatry. The authors have used the testimonies of 29 French psychiatrists who had been invited by the review Psychiatrie Internationale and who had been asked the question: “Why have you chosen to study psychiatry?” These texts were compiled and published in 1993 and have undergone content analysis. The results show that in order to explain this choice of studies, it is necessary to consider objective factors (social background, level of achievement during internship, etc.), contingent elements (encounters with professors and/or patients), and more subjective processes which make the choice of this medical specialization an answer to each person''s problems. Furthermore, the specificities of this original corpus show the importance of socio-historical conditions under which the choice of studies is done and invite us to reconsider the issue through the current context. [Copyright &y& Elsevier]

This paper briefly recalls principles which control the classification in category conduct disorders in the “French Classification of Children and Adolescent Mental Disorders R-2000”. (CFTMEA R-2000). [Copyright &y& Elsevier]