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Le trouble bipolaire est une maladie chronique gravement invalidante pour laquelle le traitement médicamenteux, qui repose sur la prescription de thymorégulateurs, est indispensable. L’objectif principal de tout soignant est d’augmenter l’adhésion aux traitements et que l’observance aux thymorégulateurs soit la meilleure possible. Le temps nécessaire à l’acceptation du trouble est très individuel et peut demander plusieurs années. Les démarches psychoéducatives, apparues il y a tout juste 30 ans visent à augmenter les connaissances sur la maladie, les traitements pharmacologiques et psychologiques et permet l’identification des conséquences du trouble ainsi que l’apprentissage de moyens pour y faire face. Des travaux récents suggèrent que le niveau d’insight de la maladie permettrait de prédire le profit que tire le patient d’une démarche psychoéducative sur la maladie, dans le sens où les patients qui ont un meilleur insight augmenteraient davantage leurs connaissances sur leur maladie et les traitements que les autres. Mieux connaître sa maladie permettrait de mieux gérer ses traitements médicamenteux et psychologiques et aiderait à réduire le taux de rechutes et les conséquences psychosociales. Il s’agit d’évaluer l’efficacité d’une démarche de psychoéducation sur l’acceptation du trouble de 32 patients bipolaires de type I résistants. Tous ont participé à 8 séances de psychoéducation issues d’un programme TCC long en 20 séances selon le programme de Lam, qui constitue l’une des références internationales pour le trouble bipolaire. Chaque patient a été évalué avant et après les 8 séances de psychoéducation à l’aide des questionnaires suivants : la Mood Disorder Insight Scale (MDIS) (Sturman et Sproule, 2003), « Tester ses connaissances du trouble bipolaire » (Basco, 2008), « Évaluation des connaissances de base sur les troubles bipolaires » (Bauer et Mc Bride, 1996). Notre hypothèse est que la psychoéducation permettrait aux patients bipolaires d’accéder à une meilleure acceptation du trouble. Les résultats seront présentés et discutés.

The objectives of this study were to investigate the social behavior, interrelations, cohesion, efficiency and team formation of the crew during 60 days of isolation and confinement, to make a critical comparison of a variety of test methods used for this purpose and to formulate recommendations for their applications in selection, training and support for future studies of this kind. The study consisted of three phases: (1) the pre-isolation period, in which initial individual and group assessment were made to understand the motivation, characteristics, and styles of the crew members, the state of the crew, and to make a prognosis for the behavior of the group and its members, (2) the isolation period, with tests and observations to follow and analyze behavior and group dynamics of the crew, and to detect manifestations of stress, and (3) the post-isolation period with final assessment and debriefing. During these three periods individual and group tests were carried out. Direct methods, questionnaires and tests, as well as indirect methods, observations of behavior, were used. These had cognitive, affective-emotional and social components; they were quantitative, qualitative or a combination. Before isolation the crew members expressed strong confidence in the team and in their own personal capability. The leadership of the Commander seemed uncontested. Crew functioning during this period was conflict-free, but was structured in a rather rigid and defensive way (isolation of affects, denial of anxiety). Apparently, the members strongly needed to present a good image image of themselves. The relatively short period of the experiment, and the absence of real risk suggested that the crew would be able to maintain their cohesion, but in a real spaceflight situation this behavior could be inadequate and even dangerous. The pre-isolation prognosis for crew behavior during isolation was validated to a large extent. During isolation there were no clear manifestations of stress. Nevertheless, the confinement and isolation were experienced as the major stress factors. The crew members described themselves as a heterogeneous but harmonious group that was successful in their mission. In fact, the team maintained its cohesion by opposing external authority, using management as a scapegoat. Occasionally, in times of crisis, they also criticized ground crew. The Commander supported this attitude. Strongly differences in personality and behavior were noted. Analysis of the sociometric data showed that the asserted harmony was more apparent than real. It is questionable whether the group cohesion would have persisted in a life threatening crisis or even in a prolongation of the experiment. The most reliable instruments for this type of survey seem to be: group methods, non-obstructive tests, indirect instruments, and qualitative tools. The least reliable are: strictly quantitative methods, self-evaluations, standard debriefing techniques, since these reinforced in most cases subjects' defenses in an unconscious avoidance of criticism. Several recommendations were made for the organization, definition of objectives, experiment selection, crew selection, roles of external management and personnel. In particular, it is felt to be necessary to explain the aims of the mission to the subjects, to give clear and complete information, to establish confident and cooperative relations with the crew. It is essential to allow dialogue, to take opinions and suggestions of the crew seriously, and to establish clear rules of confidentiality.

Subjects in whom it was found that after a month's treatment with beta-blockers there was a fall of not less than 10 mmHg in systolic blood pressure persisting 54 h after cessation of treatment were considered to have “adapted”. Significant falls of blood pressure and heart rate were observed, and were still present after two further weeks of treatment with placebo, but these adaptations were not correlated with each other. Fourteen hypertensive patients and five normotensive subjects received oral propranolol 80 mg, or metoprolol 100 mg, twice daily for 5 days. They were studied before treatment, and 54 h after the last dose. Drug administration was continued for a further 26 days, and the subjects were again examined 54 h after cessation of treatment. Blood was withdrawn at the times of study and contained negligible amounts of drug in the plasma. Records were made of blood pressure and ECG at rest and after exercise, the post-exercise QT being measured at a heart rate of exactly 100 beats per minute, obviating the need for any correction of QT. QT intervals were significantly prolonged, both at rest and on exercise. Responses to intravenous propranolol 10 mg or metoprolol 20 mg were also measured during the study periods, and no hypersensitivity to the drugs was found at rest or after exercise.