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Copyright of Psychiatrie Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cet article s'intéresse au signe du miroir en tant qu'élément de la sémiologie psychiatrique. Considéré comme prodrome de la schizophrénie lors de sa description entre 1927 et 1930, l'article veut éclairer son devenir dans l'époque actuelle notamment au regard des modifications de la société concernant le rapport du sujet à son image comme à son rapport à l'identité. Après être revenu sur l'histoire de la découverte et de la description de ce signe, afin d'en éclairer les origines et d'en retenir quelques éléments essentiels, nous reprenons l'hypothèse d'un lien entre défaillance du « stade du miroir » lacanien et apparition du signe du miroir. Des liens entre description princeps, fréquence des troubles de l'image du corps dans la psychose, et conséquence du stade du miroir sur l'identité symbolique sont éclairés. Quelques fragments cliniques viennent questionner l'hypothèse dépliée. Le signe du miroir est apparu au début du 20e siècle comme étant pronostic de la schizophrénie. Les aliénistes le relient à l'homosexualité, considérée alors comme pathologique. Il apparaît aujourd'hui que la clinique des troubles qui peuvent y être référés dans une acception large du phénomène ressortent plus d'une disjonction entre image du corps et identité. Ce signe peut être heuristiquement mis en perspective avec le propos lacanien déplié dans « Le stade du miroir comme formateur de la fonction du Je », et avec l'hypothèse que la structure psychotique offre aussi aux sujets des possibilités de réponses symptomatiques non standards. Le signe du miroir et les réponses subjectives qui en découlent éclairent une partie de la clinique des sujets cherchant à se créer, par un travail sur leur image, sur leur corps, une identité nouvelle, pour répondre à une disjonction initialement ressentie entre image et identité. Si le signe du miroir est à l'origine d'un nombre de réponses subjectives visant à modifier réellement le corps pour le faire conjoindre à une identité nouvelle, et par là porteur de solutions néo-identitaires viables, il ne s'éprouve pourtant pas sans un certain malaise. Rien ne permet de prédire son devenir, et l'action thérapeutique se limite à repérer ce signe et soutenir les éventuelles élaborations des sujets qui visent à produire une conjonction entre image et identité. Le signe du miroir, cent ans après sa découverte, constitue encore un élément de sémiologie psychiatrique extrêmement pertinent. S'il ne constitue pas nécessairement un prodrome de la schizophrénie, il traduit avant tout une difficulté du sujet à faire conjoindre son image avec son identité. La réponse symptomatique du sujet ne nécessite pas la validation du clinicien, elle témoigne d'un malaise subjectif qui lui, peut trouver à être accueilli, quelle que soit l'issue de ce signe. This article focuses on the "mirror sign" as an element of psychiatric semiology. Considered as a prodrome of schizophrenia during its description between 1927 and 1930, the article aims to shed light on its contemporary relevance, particularly with regard to changes in society concerning the subject's relationship to their image as well as the relationship to identity or self. After reviewing the history of the discovery and description of this sign, in order to shed light on its origins and on some essential elements, we take up the hypothesis of a link between a failure of the Lacanian "mirror stage" (stade du miroir) and the occurrence of the sign of the mirror. Links between original description, the frequency of body image disorders in psychosis, and the consequence of the mirror stage on symbolic identity are clarified. A few clinical fragments allow us to question the unfolding hypothesis. The mirror sign appeared at the beginning of the 20th century as a prognosis for schizophrenia. Alienists linked it to homosexuality, then considered pathological. It appears today that the clinical class of the disorders that can be referred to this sign emerges essentially from a disjunction between body image and identity. This sign can be heuristically put into perspective with the Lacanian statement unpacked in " Le stade du miroir comme formateur de la fonction du Je ," and with the hypothesis that the psychotic structure also offers subjects the possibility of non-standard symptomatic responses. The sign of the mirror and the subjective responses that result from it shed light on what it is that some subjects seeking to create, by working on their image, on their body, a new identity, to respond to an initial perceived disjunction between image and identity. If the sign of the mirror inspires a large number of subjective responses aimed at modifying the body to make it conform to a new identity, and thereby carrying viable neo-identity solutions, it is not experienced without some discomfort in most cases. Nothing makes it possible to predict its future, and the therapeutic action is limited to identifying this sign and supporting the possible elaborations of the subjects who aspire to produce a conjunction between image and identity. One hundred years after its discovery, the mirror sign, is still an extremely relevant element of psychiatric semiology. It does not necessarily constitute a prodrome of schizophrenia, but it indicates a subjective difficulty in associating image with identity. The symptomatic response of the subject does not require the validation of the clinician; it is linked to a subjective malaise, which can be welcomed, whatever the outcome of this sign. [ABSTRACT FROM AUTHOR]

Notre article argumente l'intérêt de la dimension du contact, telle que saisie par la phénoménologie psychiatrique, pour les cliniciens orientés par la psychanalyse et travaillant en psychiatrie. Nous situons d'abord le contact par rapport aux concepts de transfert et de contre-transfert, en proposant d'inverser la logique faisant du contact une sous-dimension de la dynamique transféro-contre-transférentielle. Nous affirmons au contraire que le contact, comme dimension « basale » de l'expérience humaine, colore cette dynamique dans l'ici et le maintenant de chaque séance. Afin d'estimer l'intérêt de l'usage de la dimension contactuelle comme indicateur diagnostique, nous élargissons la logique du Praecox Gefülh pour proposer une démarche de typification des grandes formes cliniques rencontrées en psychiatrie faisant du contact non un signe métonymique de la maladie, mais un objet structurellement homothétique à l'entité clinique dont souffre le sujet. Nous prenons l'exemple de quatre configurations du contact : la perte de la vitalité dans la schizophrénie ; l'introuvable authenticité de l'hystérique ; l'impossible fluidité chez le mélancolique ; l'échec de l'ancrage maniaque. Nous proposons, que certaines modalités contactuelles seraient des « anti-contact », empêchant une véritable rencontre clinicien-patient d'avoir lieu. Nous affirmons que l'étude du contact pourrait devenir, pour les cliniciens orientés par la psychanalyse comme pour ceux travaillant avec la phénoménologie, un élément fondamental de la psychiatrie dimensionnelle, à rebours des logiques étiologiques de la psychiatrie biologique. The clinician who adopts a psychoanalytic approach in a psychiatric context often regards the encounter between two individuals as an interplay of subjectivities, whose mode of being-in-the-world is shaped by their unique historical experiences. Despite some psychoanalytic authors exploring the concept of "contact," it has often been reduced to its similarity with transference and countertransference, with little attention given to its distinctive qualities. This limits psychoanalysis in its ability to conceptualize an unmediated, preverbal encounter between two individuals. In this article, we argue that the dimension of "contact" cannot be equated with transference, and that it constitutes a vital tool for diagnosing and guiding therapy for various clinical conditions commonly encountered in psychiatry. This article is based on theoretical considerations. We first worked on the history of the concept of contact, then of Praecox Gefühl in the works of H.C. Rümke, to which we added the findings of current studies on the relevance of Praecox Gefühl in the diagnosis of schizophrenia and the study of the works of the great phenomenological psychiatrists. In so doing, we aimed to show that contact could be a tool of great use for psychiatric diagnosis, insofar that it allows for a typification of the forms of existence of different patients. H.C. Rümke's investigation of the concept of Praecox Gefühl highlights the unique mode of contact observed in schizophrenia. It is distinct from the feeling of strangeness and involves an intuitive observation of a perceived distance within the clinical relationship. Given that many psychiatric pathologies can cause patients to withdraw from the shared world, we suggest that the notion of Praecox Gefühl , beyond its original designation of the clinician's experience of schizophrenic dissociation and the particularities of the schizophrenic mode of being-in-the-world, may be applicable to other pathologies studied in psychiatric phenomenology. We propose four main forms of contact: the loss of vitality in schizophrenia, the untraceable authenticity of the hysteric, the impossible fluidity in the melancholic, and the failure of anchorage in mania. By approaching contact as a fractal form that reveals the entire mode of the subject's being-in-the-world, this typifying approach goes beyond a purely semiological or etiological reflection and can be diagnostically useful in guiding therapeutic efforts to enhance the subject's capacity to truly engage with others. Our paper focuses on the relationship between contact and what clinicians commonly refer to as an "encounter". It is important to recognize that contact is not always equivalent to an encounter, and that assuming otherwise risks overlooking the possibility that certain relational modalities could actively prevent such an encounter from taking place. These "anti-contact" modalities, exemplified by the Praecox Gefühl , necessitate a focus on the very possibility of being in a therapeutic relationship with the clinician. Therefore, we suggest that clinicians should work to establish the possibility of being in a relation with the patient, prior to attempting to create an encounter. This approach allows for a more nuanced understanding of the ways in which patients can either facilitate or hinder the development of an encounter, and highlights the importance of working on establishing the possibility of a real encounter and being-with the clinician. This paper has sought to challenge the prevailing assumption among psychoanalytically oriented clinicians that contact is merely a sub-dimension of the transferential dynamic. Instead, we have argued that contact warrants specific attention as a tool for both diagnosis and therapy in psychiatry. By examining the example of the Praecox Gefülh , we have proposed a typifying approach that could be applied to the most common clinical entities encountered in psychiatry, based on the clinician's perception of specific modalities of contact within the therapeutic consultation. This reflection on contact and anti-contact is a necessary and contemporary contribution to the psychiatric field, which is increasingly embracing a dimensional approach to psychological pathologies. By prioritizing the dimension of contact, we can deepen our understanding of the nuances of the therapeutic relationship and can enhance our ability to help patients overcome barriers to connection and encounter. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic a number of ethical challenges have arisen in the healthcare system. A psychological response to moral challenges is termed moral distress (MD). Objective: Identification of causes of MD in inpatient psychiatric care in the context of the COVID-19 pandemic in Germany. Material and methods: A survey was conducted using a self-administered non-validated online questionnaire as part of a cross-sectional study, in which 26 items about the experience of MD were examined and open questions about the handling of the pandemic and its effects on everyday work were posed. Physicians who worked in inpatient psychiatric care during the COVID-19 pandemic in Germany were surveyed anonymously with a convenience sample. The data acquisition took place between 17 November 2020 and 6 May 2021. Results: A total of 141 participants were included. They indicated multiple pandemic-related changes in their daily work partly resulting in MD. Conclusion: MD is a neglected potential burden of inpatient psychiatric care under pandemic conditions (and beyond), which requires further research and an adequate handling. These results include implications for decision makers in crisis teams as well as a need for support services such as clinical ethics consultation services. [ABSTRACT FROM AUTHOR]

Devant l'augmentation du nombre de cas de COVID-19, l'Établissement Public de Santé (EPS) de Ville-Évrard a mis en place des mesures strictes pour minimiser les risques d'infection et pour assurer la continuité des soins. Dans ce contexte, il nous a paru pertinent de s'intéresser au vécu de la crise sanitaire par nos patients hospitalisés lors de la première vague. Notre équipe a élaboré un questionnaire semi-structuré, composé de 8 items, permettant au patient de s'exprimer librement sur leur vécu de la crise sanitaire, de la prise en charge durant cette crise et du confinement. Nous avons recueilli les témoignages de 12 patients en réponse aux différents items du questionnaire concernant leur vécu en abordant les différents aspects de la crise sanitaire, parmi ceux qui ont été touchés par la COVID-19 et ceux qui ne l'ont pas contractée. Les réponses apportées par les patients aux différents items du questionnaire ont permis d'évoquer leur vécu de la crise sanitaire et du confinement. Nos patients ont fait preuve d'une bonne conscience de la complexité de la situation tout en se montrant coopérant à leur prise en charge et en respectant les nouvelles mesures mises en place. Ce travail nous a permis de constater que le retentissement de la crise lors de la première vague a été globalement bien vécu par nos patients avec une prise de conscience satisfaisante des risques encourus. Since the beginning of the health crisis, health care personnel have been confronted with an influx of patients with COVID-19. Given the complexity of the situation, the reorganization of care was done on an emergency basis to ensure careful management to limit the spread of the disease among health care personnel and patients. As patients suffering from psychiatric disorders were not spared, the Ville-Évrard Public Health Establishment set up a strategy to deal with this crisis by setting up a COVID+ unit specialized in the care of patients suffering from mental disorders and infected by the Coronavirus. Patients diagnosed as positive by PCR test were transferred to this unit so that they could benefit from a global management. The aim of our work was to focus on psychiatric patients (whether they were carriers of the COVID-19 virus or not) on their experiences during the health crisis in the first wave from March to June 2020, during the first containment. We have developed a semi-structured questionnaire composed of 8 questions, allowing to explore different aspects of the experience of the health crisis. We interviewed 12 patients (six patients affected by COVID-19 and six unaffected patients) with different mental disorders. The patients expressed themselves freely and their answers to the questions were presented question by question and separated according to the two groups. The first question was intended only for patients in the first cluster infected with the Coronavirus and the second question for patients with a family member infected with the virus. For the first question, two patients among the six infected with the Coronavirus, expressed anxiety. For the second question, two patients in the Covid+ group had a family member who had contracted the virus. One patient felt guilty, and one patient was anxious. In the Covid− group, one patient whose spouse had contracted the virus was very worried. For the third question, in the Covid+ group, four of the six patients were compliant with containment, two patients were not. In the Covid− group, four patients experienced containment between home and the hospital, and two patients experienced the entire containment at home. Regarding the fourth question, all patients (in both groups) acknowledged that the health crisis had a significant impact on their lifestyle. In response to the fifth question, all patients in the Covid+ group talked about their stay in the COVID+ unit and its setting. For patients in the Covid− group, the answers were varied mentioning simple means of distraction. For the sixth question, all patients (in both groups) were globally satisfied with their care. Concerning the seventh question, all patients in the Covid+ group thought they had been sufficiently careful without expressing any fear about the risk of contamination. In the Covid− group, the answers were centered on the fear of contracting the virus in the hospital. The responses to the eighth and final question were marked by a glimmer of hope. In the light of this work, the repercussions of this crisis, during the first wave, were generally well experienced by our patients, in the psychiatric environment, with a good awareness of the stakes and the risks incurred but also with a glimmer of hope for a resolution of the situation soon. Finally, most of the psychiatric patients in this sample behaved as respectful citizens during this first wave of confinement. [ABSTRACT FROM AUTHOR]

Copyright of Sante Mentale au Quebec is the property of Revue Sante Mentale au Quebec and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Psychiatrie und Psychotherapie sind besonders stark von der herrschenden Kultur abhängig. Im letzten halben Jahrhundert, in der der Autor als Universitätsprofessor, Klinikchef und Therapeut in eigener Praxis tätig war, haben sich Psychiatrie und Psychotherapie vielfältig verändert. Unter Berücksichtigung des gesellschaftlichen Wandels und der damit zusammenhängenden Veränderungen des menschlichen Selbstverständnisses wird auf den Wandel der psychischen Krankheitsformen eingegangen. Schon heute lässt sich eine Tendenz zur Verdinglichung der Gefühle und eine verstärkte Beschäftigung mit dem Selbstwert feststellen. So sind Schuldgefühle bei schwer depressiv erkrankten Menschen heute seltener geworden. Gleichzeitig ringen depressive Menschen häufiger mit Kränkungen und verletztem Selbstwert. Auch das «Selbst» wird hauptsächlich reflexiv wie ein Objekt verstanden. Präreflexive, gleichsam leib-seelische Anteile erhalten auch in Psychotherapien wenig Aufmerksamkeit. Diese Tendenz könnte durch die Digitalisierung mit Big Data noch verstärkt werden. Umso wichtiger ist eine Auseinandersetzung mit der Zukunft von Psychiatrie und Psychotherapie auch in Kenntnis ihrer Geschichte. [ABSTRACT FROM AUTHOR]

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

The German S3 guidelines on prevention of coercion: prevention and therapy of aggressive behavior in adults (2018) are cross-sectional guidelines that in addition to medical scientific evidence also touch to a great extent on questions of ethics and law as well as organizational structures of the healthcare system. Accordingly, in addition to the research on evidence, the consensus process also had a strong weighting in the development of the recommendations. The appropriate participation of experts from various fields and their representation in the consensus group was therefore of central importance. Particularly important is the implementation into clinical practice by means of the recommendations for implementation of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) for psychiatric wards, psychiatric clinics, and care regions. For psychiatric wards, the recommendations are being evaluated with a multicenter randomized controlled trial (RCT), the PreVCo study. [ABSTRACT FROM AUTHOR]

Assisted suicide has been the subject of controversial debates for years, particularly intensively since a ruling by the Federal Constitutional Court of Germany (BVerfG) in 2020, which postulated that the only prerequisite for the legitimacy of assistance is the free decision to commit suicide. This brings the issue into the focus of psychiatry. On the one hand, because people with mental illnesses can seek assisted suicide and on the other hand, because these illnesses often but not necessarily limit the ability to make a free decision on suicide. In the area of tension between the medical obligation to life and to suicide prevention on the one hand and the obligation to respect autonomous decisions of patients on the other hand, psychiatrists are not only personally challenged to develop a moral stance, but also as a profession to define the role and obligations of the discipline. This overview aims to contribute to this. [ABSTRACT FROM AUTHOR]

During the era of National Socialism around 300,000 people were murdered in the "euthanasia" programs. The majority of those killings took place in asylums, whereas no killings in psychiatric and neurological university (PNU) hospitals have so far been identified. Furthermore, there were no deportations from these hospitals to the gassing asylums. Nevertheless, the PNUs took part in the "euthanasia" by transferring patients to asylums, where many of them were either killed or deported to gassing asylums. There are only a few studies that empirically describe these transfers. In this study the rates of transfers of the PNU Frankfurt am Main are reported for the first time, thus allowing a judgment of the involvement in the "euthanasia" programs. The rate of patients transferred to asylums dropped from 22–25% in the years before to around 16% in the years after knowledge about the mass killings in the asylums spread in the PNU Frankfurt. Of the patients transferred between 1940 and 1945, 53% died in the asylums before 1946. The high mortality rate of the transferred patients underlines that the role of the PNUs in the "euthanasia" programs should be examined in more detail. [ABSTRACT FROM AUTHOR]

Depuis trois ans, mes collègues et moi-même animons un séminaire d'épistémologie de la psychiatrie. C'est sur cette expérience commune en plus de chacune des nôtres (cliniciens, philosophes...) que nous sommes fondés à aborder la question de l'ouverture en psychiatrie. À quelles fins ouvrir la psychiatrie ? Quelle idée du progrès poursuit-on ? Nous avons, au cours de ses années de travail, eu la chance de pouvoir tenir un fil qui lie les très diverses contributions qui nous ont été apportées, tant du côté de l'histoire de notre discipline, que de la psychanalyse, de la philosophie des sciences, de l'anthropologie, des savoirs expérientiels. Nous faisons le constat que la psychiatrie n'existe dans sa définition complète et satisfaisante que dans le débat que nous avons fait vivre avec ceux qui ont quelque chose à en dire depuis une place qu'on aurait pu juger extérieure : historien, psychanalyste, anthropologue, philosophe... Si un corpus théorique se croit suffisant pour dire la chose psychique, il a tort; pourtant si on verse dans la psychiatrie intégrative on s'éloigne autrement, mais irrémédiablement de la vérité scientifique sur notre objet. Nous proposons donc une nouvelle manière de décrire la pratique de la psychiatrie : inspirés par la psychothérapie institutionnelle qui propose de réunir les transferts de chacun des participant aux soins en en respectant l'intégrité subjective, nous posons qu'il est possible de réunir une constellation épistémique pour chacun de nos efforts de soin, réunissant les savoirs nécessaires à celui-ci sans les dénaturer ni leur faire perdre leur radicalité. For three years, my colleagues and I have been leading a seminar on the epistemology of psychiatry. Based on this shared experience, in addition to our own personal experiences (as clinicians, philosophers, etc.), we tackle the question of openness in psychiatry. What does psychiatry open up to ? What idea of progress are we pursuing ? We have, during these years of work, been lucky enough to be able to grasp a common thread that links the very diverse contributions that have been presented in our seminar, both in terms of the history of our discipline, as well as psychoanalysis, the philosophy of science, anthropology, experiential knowledge. We note that psychiatry exists in its complete and satisfactory definition only in the debate that we have facilitated with those who have something to say about it from a place that could be judged external: historian, psychoanalyst, anthropologist, philosopher.. If a theoretical corpus believes itself sufficient to speak about the psychic thing, it is wrong; however, if we veer into integrative psychiatry we move away differently, but irremediably, from the scientific truth of our object. We therefore explain a new way of describing the practice of psychiatry: inspired by institutional psychotherapy, which proposes to bring together the transferences of each of the participants in care while respecting subjective integrity, we posit that it is possible to bring together an epistemic constellation for each of our caregiving efforts, bringing together the knowledges necessary for this without distorting them or causing them to lose their radicality. [ABSTRACT FROM AUTHOR]

À partir d'une brève histoire de l'ouverture des services en psychiatrie et de l'expérience du travail dans un hôpital ouvert depuis sa création en 1975, il s'agira de questionner les effets concrets de l'ouverture dans ses dimensions éthiques, cliniques et psychopathologiques afin de penser cette ouverture comme un outil de soins à part entière. Ce texte s'appuie sur des publications scientifiques au sujet de la politique des portes ouvertes en psychiatrie ainsi que sur l'expérience clinique dans un Centre hospitalier spécialisé du Sud-Est de Marseille. Maintenir tous les services d'un hôpital ouverts n'est pas une décision du quotidien, si la question était posée au jour le jour, nous aurions quotidiennement de bonnes raisons de fermer. Il s'agit d'une position collective et c'est collectivement que nous portons les risques de l'aller et venir librement de soignants et patients. Sans doute faut-il sortir du risque zéro, idéal impossible et paralysant. Plusieurs études comparant services ouverts et services fermés concluent que les services psychiatriques ouverts ont un moindre recours aux mesures coercitives. L'ouverture des portes produit de façon très concrète des effets pour les patients et pour les soignants, bien au-delà de la liberté de circulation ou de sa restriction. La thérapie n'opère pas par la simple ouverture des portes, mais l'ouverture des portes permet des modalités cliniques et transférentielles inédites et discontinues grâce à la mise en circulation (des idées, des personnes, etc.). Le travail actuel, mené à l'hôpital pour le moindre recours et, à terme, la suppression des chambres d'isolements, s'inscrit également dans cette dynamique. L'existence de groupes de travail ouverts aux patients et aux soignants et la mise en circulation que ces lieux d'échange opèrent sont déjà, en soi, une subversion des pratiques asilaires. Nous espérons que cela permet une dynamique de soins renouvelée. Via a brief history of Open-Door Policy (ODP) in psychiatry, we discuss its implications and consequences in daily practice (in ethical, clinical, and psychopathological terms). We think that open-door policy in psychiatry is a tool of care in its own right. We conducted a literature review to analyze ODP in psychiatry in Europe and also made use of clinical experience in a psychiatric hospital in Marseille, France. ODP in this hospital is not a daily decision; we would otherwise have good reasons to close our doors every day. This is a collective position and we bear the risks of the collective, free coming and going of caregivers and patients. It requires us to get out of the zero-risk policy mindset, which we consider an impossible and paralyzing ideal. Several studies comparing open- and closed-door policy in psychiatry suggest that open-door services have less recourse to coercive measures. The ODP produces concrete effects for patients and caregivers, beyond the freedom of movement or its restriction. ODP allows for new clinical and transferential modalities due not only to the openness but also the renewal of patients' fundamental rights to freedom. ODP maintains a better long-term therapeutic collaboration between patients and caregivers. [ABSTRACT FROM AUTHOR]

La psychiatrie comme discipline est portée vers l'autre et l'altérité ; non pas simplement celle pour le patient et sa problématique psychique mais aussi pour des savoirs extérieurs. Reconnaissant ses propres limites et son incapacité à penser seule, la psychiatrie, dont le savoir qui lui est spécifique est sans doute assez limité, se tourne depuis l'origine vers d'autres disciplines. Cet article ne cherche pas à proposer un nouveau modèle susceptible d'articuler cette hétérogénéité conceptuelle, mais essaie de comprendre comment s'effectue ce mouvement d'ouverture vers d'autres disciplines. La psychiatrie y trouve indéniablement une richesse mais son inféodation à des courants qui lui sont extérieurs ne risque-t-il d'accentuer sa dissolution et de faire disparaître son identité ? En s'appuyant sur la distinction proposée par G. Lantéri-Laura entre disciplines intrinsèques (soit des disciplines cliniques comme la neurologie, psychanalyse) et disciplines extrinsèques, qui utilisent une élaboration théorique qui ne doit rien à la clinique (comme l'anthropologie, l'histoire ou la linguistique), cet article s'attachera à partir de nombreux cas particuliers à montrer l'apport des disciplines extrinsèques tout au long de l'histoire de la psychiatrie. Cet article cherche à décrire plusieurs modalités d'articulation de la psychiatrie aux savoirs extrinsèques, en s'intéressant plus précisément aux sciences humaines et sociales et à l'histoire. Dans un premier temps, on étudie le mouvement par lequel la psychiatrie va chercher dans des sciences affines un appui pour sa pratique, une éthique des soins, voire un « troisième œil » critique qui puisse lui offrir ce recul sur une pratique souvent décriée. Dans un second temps, cette étude se propose d'examiner combien la psychiatrie, le savoir qu'elle isole concernant la question de la folie, ouvre par lui-même à une interrogation sur l'homme qui peut être pris en compte par les autres disciplines. La sociologie démontre notamment comment les catégories cliniques peuvent être liées aux préjugés et aux idéaux d'une culture et d'une époque. L'histoire montre comment un événement comme celui de la libération des chaînes par Pinel peut bénéficier d'interprétations historiques, dont les significations ne sont jamais épuisées. La psychiatrie s'inspire des autres savoirs mais ces emprunts s'effectuent souvent à partir de déplacements qui traduisent la nécessité d'une adaptation aux enjeux cliniques. Ces savoirs extrinsèques ne sont jamais importés sans transformation et sans une part d'infidélité. Réinterroger ce qui est le plus évident, remettre en question ce qui paraît le plus coutumier, tels sont les bénéficies que la psychiatrie peut obtenir en choisissant de se décentrer et de faire appel aux disciplines extrinsèques à la clinique. La prise en compte des sciences humaines et sociales dans la compréhension des troubles psychiques est aujourd'hui bien établie. Le dialogue qui résulte de la rencontre de disciplines hétérogènes n'a pas pour but d'aboutir à un consensus. L'exercice clinique de la psychiatrie conserve des spécificités fortes liées à l'exercice de la rencontre avec le désordre mental. Le savoir qui en résulte est irréductible aux autres disciplines. L'acte psychiatrique repose sur une responsabilité incombant aux seuls cliniciens, irrémédiablement divisés par les enjeux auxquels ils doivent faire face. Psychiatry as a discipline is oriented towards the other and towards otherness; not only that of the patient and of their psychological issues, but also for the alterity of external knowledge. Recognizing its own limitations and its inability to think alone, psychiatry, whose specific knowledge is undoubtedly quite limited, has since the beginning turned to other disciplines. This article does not try to propose a new model likely to articulate this conceptual heterogeneity, but tries to understand how this movement of opening towards other disciplines is carried out. Psychiatry undeniably finds a richness in this, but does not its subservience to currents that are external to it risk accentuating its dissolution and making its identity disappear? Based on the distinction proposed by G. Lantéri-Laura between intrinsic disciplines (i.e. clinical disciplines such as neurology, psychoanalysis) and extrinsic disciplines, which use a theoretical elaboration that owes nothing to clinical engagement with subjects (such as anthropology, history, or linguistics), this article will endeavor to show the contribution of extrinsic disciplines throughout the history of psychiatry, using a number of specific cases. This article describes several ways in which psychiatry is linked to extrinsic knowledge, focusing more specifically on the human and social sciences and on history. Firstly, we study the movement by which psychiatry seeks support for its practice, an ethic of care, and even a critical 'third eye' that can offer it this perspective on a practice that is often decried. Secondly, this study proposes to examine the extent to which psychiatry, through the knowledge that it isolates concerning the question of madness, opens up by itself to a questioning of humanity that can be taken into account by other disciplines. Sociology shows, in particular, how clinical categories can be linked to the prejudices and ideals of a culture and an era. History shows how an event such as Pinel's liberation from chains can benefit from historical interpretations, the meanings of which are never exhausted. Psychiatry is inspired by other knowledges, but this borrowing is often based on displacements that reflect the need to adapt to clinical issues. This extrinsic knowledge is never imported without transformation and without some infidelity. Re-examining what is most obvious, questioning what seems most customary, these are the benefits that psychiatry can obtain by choosing to decentralize and to call upon disciplines extrinsic to the clinical. The inclusion of the human and social sciences in the understanding of psychological disorders is now well established. The dialogue that results from the meeting of heterogeneous disciplines is not intended to lead to a consensus. The clinical practice of psychiatry retains strong specificities linked to the exercise of the encounter with mental disorder. The resulting knowledge is irreducible to other disciplines. The psychiatric act is based on a responsibility incumbent on the clinician alone, irremediably divided by the issues he or she must face. [ABSTRACT FROM AUTHOR]

En France, la création à Paris de l'hôpital Henri-Rousselle et son service ouvert – d'hospitalisation psychiatrique non soumis à la Loi du 30 juin 1838, il y a tout juste cent ans, marque traditionnellement la fin de la période asilaire. Dans le premier quart du siècle dernier, plusieurs autres expériences avaient toutefois été conduites dans la même perspective d'ouverture de la psychiatrie, dans les hôpitaux généraux et dans quelques établissements spécialisés avant et après la Grande Guerre. Le présent travail vise à préciser le sens de quelques termes spécialisés alors en usage dans le milieu médical et à comparer les objectifs et les moyens mis en œuvre par les auteurs de ces diverses expériences. Les rapports, publications et communications scientifiques de la période étudiée sont consultés, confrontés et analysés. L'objectif premier des services implantés au sein des hôpitaux généraux sous le nom de service de délirants, service de psychiques, salles d'isolement, etc. était d'assurer le traitement des personnes souffrant de pathologies organiques à expression psychiatrique, délirants d'hôpitaux et agités bruyants : Régis à Bordeaux en 1902, Gilbert Ballet à l'Hôtel-Dieu de Paris en 1904 ouvriront la voie à plusieurs autres réalisations. Certains de ces services ont aussi une fonction de triage, d'où, après un temps d'observation, l'aliéné est orienté vers l'asile. Les services hospitaliers publics pour maladies nerveuses proposaient aux personnes souffrant de troubles appelés psychonévroses puis névroses des cures libres aux plus démunis, tandis que les classes aisées fréquentaient les établissements privés. Quant aux services ouverts créés au sein ou en annexe des asiles, leur vocation initiale était également de répondre à ces mêmes besoins non satisfaits plutôt que d'améliorer la prise en charge des aliénés. À la Clinique d'Esquermes avec Georges Raviart et à Fleury-les Aubrais avec James Rayneau sont conduites deux expériences hors du commun, source d'inspiration pour le courant réformateur aliéniste, la première où tous les malades sont à leur entrée placés sous loi de 1838, la seconde où certains sont soumis au régime hospitalier commun. Pendant la première guerre mondiale, les Centres neuropsychiatriques militaires offrent aux médecins d'asile mobilisés un nouveau champ d'exercice auprès de psychonévrosés et confus qui ne sont pas ordinairement rencontrés dans les asiles. Le terme de service ouvert renvoie à des réalisations très diverses, répondant à des besoins particuliers, aux premiers rangs desquels l'enseignement complet aux étudiants en médecine et une meilleure prise en charge des pathologies neuropsychiatriques organiques et des pathologies névrotiques. Les réalisations visant à améliorer les soins aux aliénés dans les asiles du même nom seront aussi rares que tardives. Dans l'entre-deux-guerres, les insuffisances du système asilaire conduisent à plusieurs initiatives, dont celle d'André Mahon à Mont-de-Marsan est fort proche de ce qui sera généralisé dans les années 1950 dans les hôpitaux psychiatriques où, comme à Fleury-les-Aubrais précédemment, malades en cure libre et malades internés partagent les mêmes locaux : avec Mahon, le service est ouvert à tous. Quant à la réalisation d'Edouard Toulouse qui marquera son temps, elle inspire l'importante circulaire Rucart de 1937 et le Règlement-modèle de 1938 dont le début de mise en application devront tout de même attendre une vingtaine d'années. In France, the creation in Paris of Henri-Rousselle Hospital and its "open" psychiatric ward, not subject to the Law of June 30th 1838, one hundred years ago, traditionally marks the end of the asylum period. In the first quarter of the last century, however, several other experiments had been conducted with the same perspective of opening up psychiatry, in general hospitals and in some specialized establishments before and after the First World War. This work aims to clarify the meaning of some specialized terms then in use in the medical field and to compare the objectives and the means implemented by the authors of these various experiments. The reports, publications, and scientific communications of the period studied are consulted, compared, and analyzed. The primary objective of the services established within general hospitals (variously called wards for delirious patients, wards for psychic patients, isolation rooms, etc.) was to ensure the treatment of people suffering from organic pathologies with psychiatric expression: delirious, overexcited, and noisy persons. Emmanuel Régis in Bordeaux in 1902, or Gilbert Ballet at the Hôtel-Dieu in Paris in 1904 paved the way for other achievements. Some of these wares also have a triage function, from which, after a period of observation, the insane person is directed to an asylum. Public hospital services for nervous diseases offered to the person suffering from disorders called psychoneuroses and then neuroses , free cures for the poorest, while the wealthy classes frequented private establishments. As for the open psychiatric wards created within or as annexes to the asylums, they were also for the most part initially intended to respond to these same unmet needs, rather than to improve upon care of the insanes. At the Clinique d'Esquermes with Georges Raviart and at Fleury-les-Aubrais with James Rayneau, two extraordinary experiments were carried out, a source of inspiration for the reformist alienist current, the first in which all patients were placed under the law of 1838, the second in which some were subject to the common hospital regime. During the First World War, the military neuropsychiatric centers offered to asylum doctors enlisted a new field of practice with psychoneurotics and confused patients who were not usually encountered in asylums. The term open psychiatric ward refers to a wide variety of achievements, responding to specific needs, mainly full education for medical students and better care of organic neuropsychiatric pathologies and neurotic pathologies. The achievements aimed at improving the care of "alienated" patients placed in asylum would be a rarity and an afterthought. In the interwar period, the shortcomings of the asylum system finally led to several initiatives, including that of André Mahon in Mont-de-Marsan, which is very close to what would be generalized in the 1950s in psychiatric hospitals; as had previously been enacted in Fleury-les-Aubrais, patients hospitalized at their own request and those hospitalized against their will share the same premises: with Mahon, the ward is open to everyone. As for the achievement of Edouard Toulouse, which would mark its time, it inspired the significant Rucart Circular of 1937 and the Model Regulations of 1938, even though their practical application wouldn't taken effect for another twenty years. [ABSTRACT FROM AUTHOR]

Cet entretien se propose de cerner les avancées spécifiques de l'Hôpital Henri-Rousselle au moment de sa direction par le Docteur Georges Daumézon, au cours des années 1970. Le témoignage de Jean-Michel Gentizon, Assistant de l'Hôpital Henri-Rousselle entre 1972 et 1976, permet, en situant le contexte historique par le biais des ouvrages influents de cette période, de cerner progressivement les enjeux et les conséquences sur la psychiatrie française de l'action de Georges Daumézon. La politique d'ouverture aux différents champs de la psychiatrie prônée par Georges Daumézon à l'Hôpital Henri-Rousselle permet d'en cerner la fonction essentielle pour la psychiatrie française des années 1970. Cette institution se révèle une plaque tournante particulièrement novatrice, sollicitant les interventions des grandes figures de la psychiatrie de cette période. Son influence concerne la politique de secteur, le mouvement de la psychothérapie institutionnelle, le domaine de la recherche clinique et les conséquences politiques générales de cette action. L'entretien dans sa conclusion interroge l'évolution actuelle de la psychiatrie, des modalités d'ouverture moins favorables dans les décennies suivantes, d'un moindre dialogue entre les différents courants et les risques d'un rétrécissement plus récent des champs actuels de la recherche aux seules neurosciences. L'expérience de l'Hôpital Henri-Rousselle telle qu'elle a pu être développée par le Docteur Georges Daumézon, se révèle une illustration particulièrement favorable d'une politique d'ouverture de la psychiatrie aux différents courants de son époque comme aux différents registres des sciences humaines. This interview aims to identify the specific advances of Henri-Rousselle Hospital at the time of its direction by Doctor Georges Daumézon, during the 1970s. The testimony of Jean-Michel Gentizon, Assistant at Henri-Rousselle Hospital between 1972 and 1976, which situates the historical context through the influential works of this period, allows us to progressively identify the stakes and the consequences of Georges Daumézon's action on French psychiatry. The policy of opening up to the different fields of psychiatry advocated by Georges Daumézon at Henri-Rousselle Hospital allows us to identify its essential function for French psychiatry in the 1970s. This institution proved to be a particularly innovative hub, soliciting the interventions of the great figures of psychiatry of this period. Its influence concerns the policy of the sector, the institutional psychotherapy movement, the field of clinical research, and the general political consequences of this action. The interview in its conclusion questions the current evolution of psychiatry, the less favorable opening modalities in the following decades, a lesser dialogue between the different currents, and the risks of a more recent narrowing of the current fields of research to the neurosciences alone. The experience of Henri-Rousselle Hospital, as developed by Dr. Georges Daumézon, proves to be a particularly favorable illustration of a policy of opening up psychiatry to the different currents of its time as well as to the different registers of the human sciences. [ABSTRACT FROM AUTHOR]

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This article deals with professional/user interactions in French psychiatry and offers to distinguish four "therapeutic styles" according to their use of tools to sustain these interactions: 1°) absence of tools and informality of interactions; 2°) use of rituals to maintain contact with the patient, no formalization; 3°) use of therapeutic methods; 4°) use of tools: a) to ease expression and interactions, b) such as protocols or c) standardized. We propose to distinguish between formalization and standardization of interactions and conclude on the role of the feeling of powerlessness of caregivers in the conflict between therapeutic approaches in psychiatry. [ABSTRACT FROM AUTHOR]

The intensity of the research undertaken in recent decades into the killing of the sick during the Nazi period has produced a wealth of publications that will have a long-reaching impact; however, gaps in the research remain, both at regional level and with regard to the national campaign. This article focuses on the region of Pomerania, which in a whole range of ways followed its own course in the extermination of mentally ill and disabled people. It sheds light on a feature of the psychiatric landscape under the Nazis which has drawn little attention to date: the construction of the first crematorium within an asylum in the Third Reich, in 1940 in Ueckermünde. On the basis of archive material explored here for the first time, the role of the crematorium in the killing of the sick on a regional level is discussed, as is its link to the organizers of the centralized T4 campaign in Berlin. The article asks whether and to what extent there was, during the early phase of the "euthanasia" killings, a parallel regionally initiated extermination operation targeting the sick, and whether and to what extent this was tolerated or even supported by Berlin. It also provides interesting insights into the "knowledge transfer" between the head of the Ueckermünde asylum Hans-Dietrich Hilweg and the head of the asylum in Kaufbeuren, Bavaria, Valentin Faltlhauser, on how best to hide or minimize the traces of the murders. These insights clearly exemplify the transformation process postulated by Ernst Fraenkel from a normative state to a prerogative state. [ABSTRACT FROM AUTHOR]

Within mental health services, the recovery model has been a guiding philosophy over the past decades. This model stresses 'person-centred care' and focuses on assisting service users to live a meaningful and hopeful life even if their illness has not been cured. As part of the recovery orientation, 'peer workers' (PWs), i.e. people with lived experiences of mental illness, are increasingly employed within mental health services. In this article, the authors explore how these changes open up frontiers and set in motion boundary work and identity discussions among healthcare professionals. Empirically, the article draws on qualitative data – interviews with healthcare professionals and observations of meetings – collected in mental healthcare services in Denmark. Theoretically, the article combines literature on professional boundary work with theories on 'self-casting', 'alter-casting' and 'othering'. Analysing two sets of demarcations – those between healthcare professionals and PWs, and those between professionals and patients – the study shows how the recovery model leads to defensive boundary work as well as an opening up of boundaries. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic arrived with significant hardship. The secondary impacts of the pandemic and our response with respect to pediatric mental health has been a subject of significant discussion in the lay public, media, and decision-maker groups. The initiatives to control SARS-CoV-2 have become politicized. A narrative emerged early that strategies to mitigate the spread of the virus were harming children’s mental health. Position statements from professional organizations in Canada have been used to support this claim. The aim of this commentary is to provide a reanalysis of some of the data and research methodology used to support these position statements. Some of the direct claims such as “online learning is harmful,” should be supported by a strong evidence base with significant consensus that speaks directly to causality. We find that the quality of the studies and the heterogeneity of the results does not support the strength of the unequivocal claims made by these position statements. In a sample of the current literature examining the issue, we find that outcomes range from improvements to deteriorations. Earlier studies relying on cross-sectional surveys typically have shown stronger negative effects than longitudinal cohort studies, which often have also shown groups of children experiencing no changes to measured mental health characteristics or groups that have experienced improvements. We argue it is imperative that policymakers use the highest quality evidence in making the best decisions. We as professionals must avoid discussing only one side of heterogeneous evidence. [ABSTRACT FROM AUTHOR]

L'accès aux études médicales odontologiques, pharmaceutiques ou de sage-femmes a été ouvert à des candidats n'ayant pas effectué de première année en sciences médicales depuis l'arrêté du 26 mars 1993 abrogé et remplacé par l'arrêté du 26 juillet 2010. Cette procédure « passerelles » relative aux modalités d'admission directe en deuxième ou troisième année d'études a connu différentes modifications jusqu'à aujourd'hui. Le cadre réglementaire prévoit l'accès à ce dispositif, entre autres, aux titulaires du diplôme de Master. Les psychologues (nécessairement détenteurs d'un diplôme de Master) sont éligibles à ces dispositifs permettant l'intégration aux études médicales. Les psychologues intéressés peuvent ainsi envisager la perspective d'une carrière médicale en reprenant leurs études en milieu ou fin de premier cycle universitaire. Dans cet entretien avec Jean-Pierre Bouchard, les psychologues Sarah Thierrée, Josué Masson et Théo Lemonnier échangent autour de leurs expériences. Ils présentent le dispositif, ses apports, ses limites, ainsi que les difficultés et satisfactions qu'ils ont rencontrées en empruntant cette nouvelle voie. Access to medical, pharmaceutical dentistry or midwifery studies has been opened to candidates who have not completed a first year in medical sciences since the decree of March 26, 1993 repealed and replaced by the decree of September 2, 2010. This "gateway" device relating to the procedures for direct admission to the second or third year of studies has been subject to various modifications until the decree of July 29, 2022. The regulatory framework provides for access to this device by holders according to their initial training. Among them is the Master's degree. Thus, psychologists (necessarily holders of a Master's degree) are eligible for these systems allowing integration into medical studies. Psychologists can thus consider the prospect of a medical career by resuming their studies in the middle or at the end of their first university cycle. In this interview with Jean-Pierre Bouchard, psychologists Sarah Thierrée, Josué Masson and Théo Lemonnier discuss their experiences. They present the device, the contributions, the limits, as well as the difficulties and satisfactions they may have encountered during their experience. [ABSTRACT FROM AUTHOR]

La prévalence des troubles psychiatriques et des addictions est particulièrement élevée en population carcérale. Souvent perçue comme une problématique spécifique et « à part », la question du soin en détention a, en fait, une dimension évidente de santé publique puisque la quasi-totalité des personnes incarcérées seront in fine libérées. La période entourant la sortie de prison est une période de vulnérabilité marquée, tout particulièrement pour les personnes souffrant de troubles psychiatriques. Dans ce contexte, des équipes mobiles transitionnelles (EMOT) ont été récemment créées afin de limiter le risque de rechute et de décès au cours de cette période sensible mais aussi d'assurer un relais des soins psychiatriques vers les dispositifs de droit commun pour cette population. Dans cet entretien avec Jean-Pierre Bouchard, Thomas Fovet, Tatiana Scouflaire, Bettina Belet, Estelle Demeulemeester, Matthieu Paindavoine, Claire Gibour, Vincent Claeyman, Laureen Ghislain, Clara Narguet, Oumaima El Qaoubii, Niels Martignène, Marielle Wathelet, Maxime Védère, Anne-Hélène Moncany proposent un premier retour d'expérience de la création de ces équipes mobiles. Psychiatric disorders and addictions are highly prevalent in the prison population. Often perceived as a specific and "separate" problem, the issue of care during detention has, in fact, an obvious public health dimension since almost all people in prison will eventually be released and return to their communities. This is particularly important because the health of people released from incarceration is characterized by a range of negative outcomes, particularly in people suffering from psychiatric disorders. In this context, the Equipes Mobiles Transitionnelles (EMOT) have recently been created in France to limit the risk of relapse and death during this high-risk period but also to ensure the links between psychiatry in prison and community psychiatry. In this interview with Jean-Pierre Bouchard, Thomas Fovet, Tatiana Scouflaire, Bettina Belet, Estelle Demeulemeester, Matthieu Paindavoine, Claire Gibour, Vincent Claeyman, Laureen Ghislain, Clara Narguet, Oumaima El Qaoubii, Niels Martignène, Marielle Wathelet, Maxime Védère, Anne-Hélène Moncany provide some initial feedback on the creation of these mobile teams. [ABSTRACT FROM AUTHOR]

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Climate change and the resulting higher frequency of extreme weather events have a direct negative impact on mental health. Natural disasters are particularly associated with an increase in the prevalence of depression, anxiety and posttraumatic stress disorder. Indirect consequences of climate change, such as food shortages, economic crises, violent conflicts and forced migration, additionally represent severe psychological risk and stress factors. Climate anxiety and solastalgia, the distress induced by environmental change, are new psychological syndromes in the face of the existential threat posed by the climate crisis. Accordingly, a sustainable psychiatry must prepare for increasing and changing demands. The principles of psychiatric treatment need to focus more on prevention to reduce the overall burden on the healthcare system. Waste of resources and CO2 emissions in psychiatric treatment processes as well as infrastructure must be perceived and prevented. Psychiatric education, training and continuing education concepts should be expanded to include the topic of climate change in order to comprehensively inform and sensitize professionals, those affected and the public and to encourage climate-friendly and health-promoting behavior. More in-depth research is needed on the impact of climate change on mental health. The DGPPN becomes a sponsor and aims for climate neutrality by 2030 by committing to climate-friendly and energy-saving measures in the area of finance, in relation to the DGPPN congress as well as the DGPPN office. [ABSTRACT FROM AUTHOR]

By appropriating the tradition of the presentation of a patient, which historically legitimised psychiatric knowledge and validated nosographic classification, Lacan subverts it by tying it to analytic practice. It becomes a clinical presentation that is no longer a demonstration of the knowledge of the master. In fact, the analyst in this transference relation starts from the saying of the patient and in that way submits himself to its unconscious logic. If the patient’s knowledge thus takes centre stage, a certain number of biases should nevertheless be questioned, which could limit or even nullify the relevance of such a dispositive. [ABSTRACT FROM AUTHOR]

The amendment to the Austrian Placement Act (UbG) expands the law to consider the needs of minors. Special provisions concern voluntary placement and the consultation of the child and youth welfare agency. The aim is to ensure the flow of information to child and youth welfare and to consider the needs of minors. A crisis intervention team can be deployed in families or residential communities to resolve tensions and find alternative accommodation options. Minors have full legal capacity from the age of 14, and the court can consult child and youth welfare to clarify support needs. Judicial control is required before medical treatments of minors, unless there is an immediate danger to life, health, or severe pain. Typical restrictions for minors in hospitals must be documented and communicated to the legal guardians within 72 hours. The collaboration between psychiatric departments and schools or kindergartens is emphasized to ensure appropriate care after discharge from the hospital. [Extracted from the article]

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Objective: Mental health problems in children, adolescents, and adults with developmental disabilities (DD) are an underserviced clinical area. Although the Royal College of Physicians and Surgeons of Canada requires that experiences with patients with DD must be included during psychiatry residency training, the type and extent of this experience is not specified. The purpose of this study was to examine the current educational opportunities regarding DD in Canadian psychiatry residency programs. Methods: A survey asking about training in DD was sent to psychiatry residency directors at all 17 medical schools in Canada. The survey consisted of three sections focused on didactic teaching and clinical rotations (required and elective) in DD for residents. Results: Program directors of all psychiatry residency programs noted that their program included didactic teaching specific to DD, although the time dedicated to this differed greatly, ranging from 2 to 20 hours. Although 13 programs offered electives in DD, only five programs required residents to complete a clinical rotation specific to DD. Two programs did not have required or elective rotations in DD. Conclusion: These results suggest that training specific to DD is probably inadequate for most residents. This is likely to result in limitations in knowledge and skills required to assess and treat people with DD, decreased comfort working with them, and ultimately reduced quality and availability of psychiatric care for this underserved population. More specific and comprehensive training requirements and opportunities are needed to ensure that residents receive appropriate training in this area. [ABSTRACT FROM AUTHOR]

La question du psychotraumatisme constitue une dimension centrale de la pratique psychiatrique en milieu pénitentiaire. Le trouble de stress post-traumatique (TSPT), en particulier dans sa forme dite « complexe », est en effet largement surreprésenté en prison. Dans cet entretien avec Jean-Pierre Bouchard, Thomas Fovet, Clément Villa, Bettina Belet, Fanny Carton, Timothée Bauer, Suzanne Buyle-Bodin et Fabien D'Hondt s'appuient sur leur expérience clinique et sur de récents travaux de recherche épidémiologique pour proposer une synthèse de la question. Les aspects cliniques spécifiquement retrouvés en milieu carcéral, notamment la question des comorbidités psychiatriques/addictologiques ou du TSPT des auteurs de crime violent, sont développés. L'état actuel des connaissances en ce qui concerne la prise en charge des symptômes post-traumatiques en prison est également discuté et mis en perspective avec la réalité du terrain. Post-traumatic stress disorder (PTSD), and particularly complex PTSD, is over-represented in prisons and corrections. In this interview with Jean-Pierre Bouchard, Thomas Fovet, Clément Villa, Bettina Belet, Fanny Carton, Timothée Bauer, Suzanne Buyle-Bodin and Fabien D'Hondt draw on their clinical experience and recent epidemiological research to provide an overview of the issue. The clinical aspects specifically found in the prison environment, especially the questions of comorbid psychiatric and substance use disorders or PTSD in perpetrators of violent crime, are developed. The current state of knowledge regarding the management of post-traumatic symptoms in prison is also discussed and put into perspective with daily practice. [ABSTRACT FROM AUTHOR]

La psychiatrie a occupé de tout temps une position située à un carrefour, à un croisement, en étant riche de la diversité des courants épistémologiques qui la traversent, mais coïncidemment fragile de ce qui met en tension sa cohérence d'ensemble. Notre titre, par la coordination qu'il institue, est déjà une méprise, du moins un parti pris, au sens où il distingue, il différencie en même temps qu'il associe deux entités que seraient la psychiatrie d'un côté et la psychanalyse de l'autre. Là où, au contraire, l'enjeu se précise moins dans l'association, la combinaison des deux que dans ce que l'une subvertit l'autre, l'infuse en l'imprégnant non de la certitude mais plutôt de ce qui se pose comme hypothèse, celle d'un work in progress. Psychiatry has always occupied a position situated at a crossroads, at an intersection, being rich in the diversity of the epistemological currents which cross it, but coincidentally rendered fragile by that which places a strain on its overall coherence. Our title, by the coordination it suggests, is already a misnomer, at least a bias, in the sense that it distinguishes, it differentiates at the same time as it associates the two entities of psychiatry on the one hand and psychoanalysis on the other. Where, on the contrary, the stakes are defined less by the association, the combination of the two than by how the one undermines the other and infuse it by impregnating it not with certainty but rather with what is posed as a hypothesis, that of a work in progress. [ABSTRACT FROM AUTHOR]

One in eight people in the world has a mental disorder. In order to support them in their efforts, carers carry out a number of tasks aimed in particular at maintaining and developing their autonomy. What should the support worker's position be when the person being supported is a victim of discrimination? This article aims to answer this question by analysing cases of discrimination experienced within a mobile psychiatric team. [ABSTRACT FROM AUTHOR]

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The amendment of the Placement Act (UbG) aims to improve communication between the police, social and health authorities, and introduce specific provisions for minors. The changes will come into effect on July 1, 2023, and include regulations for admission to and discharge from psychiatric facilities, provisions for the placement of minors, as well as changes regarding treatment, restriction, termination of placement, judicial review, outpatient treatment, and absence. The reform aims to strengthen the quality of interaction with those affected and improve cooperation between relevant actors. Obligations to communicate will be introduced to improve communication and address the individual needs of patients. [Extracted from the article]

Le terme « épistémologie » est apparu chez le métaphysicien écossais James Frederick Ferrier (1808–1864), dans son ouvrage Epistemology or Theory of Knowing (1854). La généralisation de son usage n'interviendra qu'à partir de la fin du XIXe siècle dans les textes de philosophes et scientifiques anglais et continentaux, puis nord-américains. Les discussions des membres de la Société Médico-Psychologique, créée en 1852, n'ont été répercutées par les Annales Médico-Psychologiques qu'à partir de 1853. Les questions en lien avec l'Épistémologie étaient alors référées à la Philosophie de la connaissance ou à la Philosophie des sciences. Elle repose sur l'approche de l'Épistémologie comparative (G.G. Granger), historique et clinique, sur l'analyse critique du langage et leurs propres recherches. Les auteurs reprennent la partition chronologique proposée par G. Lantéri-Laura en montrant en parallèle l'évolution des questions traitées par la philosophie des sciences, puis par l'Épistémologie. Ils analysent successivement l'impact de la Philosophie des Sciences à la Société Médico-Psychologique au cours du XIXe siècle dans la période 1852–1902, puis l'ancrage de la tradition épistémologique à la Société Médico-Psychologique avec l'apport de Pierre Marchais, et l'intrusion de l'approche nord-américaine au début du XXIe siècle. Il est illusoire de rechercher une méthode scientifique unique, définitive, applicable dans toutes les situations, car l'objectif scientifique ne dispense pas du rapport au concret. Pour la psychiatrie, quelles que soient les connaissances présentées comme nouvelles, les problèmes resurgissent à partir de perspectives diverses, dans des contextes différents, car la dynamique propre au développement de chaque discipline ou sous-spécialité les réactualise périodiquement. The term epistemology was first used by the Scottish metaphysician James Frederick Ferrier (1808–1864), in his book Epistemology or Theory of Knowing (1854). The generalization of its use will not occur until the end of the 19th century in the texts of English and continental philosophers and scientists, and thereafter in North America. The discussions of the members of the Société Médico-Psychologique , created in 1852, were not reflected in the Annales Médico-Psychologiques until 1853, and questions related to epistemology were then assigned to the fields of the philosophy of knowledge or the philosophy of science. This article is based on the approach of comparative epistemology (G.G. Granger), on an historical and clinical approach, on the critical analysis of language, and on the authors' own research. Epistemology is "a critical study of the principles, hypotheses and results of the various sciences, intended to determine their logical (non-psychological) origin, their value, and their objective significance." The authors employ the chronological score proposed by G. Lantéri-Laura by showing in parallel the evolution of the questions treated by the philosophy of science, then by epistemology. They analyze successively the impact of the philosophy of science on the Société Médico-Psychologique during the 19th century during the period of 1852–1902, then the anchoring of the epistemological tradition at the Société Médico-Psychologique due to the contribution of Pierre Marchais, and finally, the incursion of the North American approach at the beginning of the 21st century. It is illusory to seek a single, definitive scientific method, which is applicable in all situations, because the scientific objective does not dispense with the relationship to the concrete. For psychiatry, whatever knowledge is presented as new, problems arise from different perspectives, in different contexts, because the dynamics of the development of each discipline or sub-specialty are updated periodically. [ABSTRACT FROM AUTHOR]

Les auteurs retracent les différentes étapes de la naissance de la Société Médico-Psychologique (SMP), qui a célébré en 2022 ses 170 ans. Ils en rappellent le contexte et notamment la promulgation, en 1838, d'un texte de loi considéré comme un texte fondateur de ce qui s'appelait alors aliénisme et deviendra la psychiatrie. Les travaux de Philippe Pinel et Jean-Étienne Esquirol ont également tenu une place essentielle dans la naissance de la Société et plus largement dans les débuts de la discipline. Trois phases sont distinguées dans la fondation de la SMP : 1843, création des Annales M dico P sychologiques (AMP) qui deviendront le bulletin de la SMP, constitution de la Société le 18 décembre 1847 annoncée par Jules Baillarger dans le numéro 1 des AMP de 1848, avec un début de règlement et une première liste de membres. Pour des raisons politiques (révolution de février 1848, coup d'État du 2 décembre 1851), la fondation officielle n'aura lieu qu'en 1852. Une commission modifie le règlement primitif. Le principe est posé d'une Société se composant de médecins, de philosophes, de magistrats, de ministres de la religion, de moralistes, d'instituteurs, de poètes, etc. Les revues professionnelles annoncent alors la formation d'une Société où « auront été rassemblés et appliqués à la fois tous les instruments de l'analyse psychologique ». La première séance se tient le 26 avril 1852. Les auteurs donnent la liste de membres fondateurs, où l'on note néanmoins quelques absents de marque. Sont abordées ensuite les relations entre la SMP et l'Académie de médecine, fondée en 1820. Sont également évoqués les premiers membres étrangers, hollandais, espagnols, italiens, russes, autrichiens, allemands et, à la fin du XIXe siècle, américains. Les pays européens verront, à la même période, la constitution de sociétés savantes similaires, notamment en Grande-Bretagne, en Allemagne mais aussi en Russie. Les auteurs détaillent la création de la Société des médecins des asiles d'aliénés américains, future American Psychiatric Association (APA), et de sa revue qui deviendra l' American Journal of Psychiatry. Sont rapportés quelques éléments de réunions communes entre la SMP et l'APA en 1978. La naissance de la SMP et celle d'autres Sociétés savantes en Allemagne, en France, au Royaume Uni marquent le début d'une discipline qui s'appelle alors aliénisme et qui deviendra la psychiatrie. The authors retrace the various stages of the birth of the Société Médico-Psychologique (SMP), which celebrated its 170th anniversary in 2022. They recall the context, notably a law enacted in 1838 that was considered as a foundation text for what was then called alienism and which would eventually become psychiatry. The work of Philippe Pinel and Jean Étienne Esquirol played an essential role in the founding of the SMP, and more broadly in the genesis of the discipline. Three phases can be distinguished in the foundation of the SMP: (1) the creation of the Annales Médico-Psychologiques (AMP), in 1843, a journal that would become the SMP bulletin; (2) the first constitution of the SMP which was announced by Jules Baillarger in the first issue of the AMP in 1848 and which included the first organizational rules and a first list of members; (3) For political reasons (The revolution of February 1848, a political coup d'état on December 2, 1851), the foundation of the SMP would officially first take place in 1852. A commission of members modified the first internal rules. A principle was established whereby the Society would be composed of physicians, philosophers, magistrates, clergymen, moralists, teachers, poets, etc. The professional journals announced at the time the establishment of a Society where "all the instruments of psychological analysis will be gathered and applied simultaneously". The first meeting of the Society was held on the 26th of April 1852. The authors provide a list of the founding members, although there were some notable absences. The relations between the SMP and the Academy of Medicine, founded in 1820, are detailed. The first international members are mentioned. They came from The Netherlands, Spain, Italy, Russia, Austria and Germany, and at the end of the 19th century, from America as well During the same time period, similar learned societies were established, notably in the United Kingdom, Germany and Russia. The authors describe in detail the creation of the Association of Medical Superintendents of American Institutions for the Insane (ASAMSAII), the future American Psychiatric Association (APA), and of its Journal which would become the American Journal of Psychiatry. The details of joint meetings between the APA and the SMP in 1978 are reported. The birth of the SMP and of other learned societies in Germany, France and the United Kingdom marked the beginning of a discipline which was then called alienism and which would become Psychiatry. [ABSTRACT FROM AUTHOR]