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Objectives: Cannabis use is common in people with early-phase psychosis (EP) and is associated with worse treatment outcomes. Few targeted interventions for cannabis use behaviour in this population exist, most focusing on abstinence, none focusing on harm reduction. Many people with EP will not seek treatment for their cannabis use with current therapeutic options. Understanding preferences for cannabis-focused harm reduction interventions may be key to improving outcomes. This study aimed to determine preferences of young adults with EP who use cannabis for cannabis-focused harm reduction interventions. Methods: Eighty-nine young adults across Canada with EP interested in reducing cannabis-related harms were recruited. An online questionnaire combining conventional survey methodology and two unique discrete choice experiments (DCEs) was administered. One DCE focused on attributes of core harm reduction interventions (DCE 1) and the second on attributes of boosters (DCE 2). We analysed these using mixed ranked-ordered logistic regression models. Preference questions using conventional survey methodology were analysed using summary statistics. Results: Preferred characteristics for cannabis-focused harm reduction interventions (DCE 1) were: shorter sessions (60 min vs. 10 min, odds ratio (OR): 0.72; P < 0.001); less frequent sessions (daily vs. monthly, OR: 0.68; P < 0.001); shorter interventions (3 months vs. 1 month, OR: 0.80; P < 0.01); technology-based interventions (vs. in-person, OR: 1.17; P < 0.05). Preferences for post-intervention boosters (DCE 2) included opting into boosters (vs. opting out, OR: 3.53; P < 0.001) and having shorter boosters (3 months vs. 1 month, OR: 0.79; P < 0.01). Nearly half of the participants preferred to reduce cannabis use as a principal intervention goal (vs. using in less harmful ways or avoiding risky situations). Conclusions: Further research is required to see if technology-based harm reduction interventions for cannabis featuring these preferences translate into greater engagement and improved outcomes in EP patients. [ABSTRACT FROM AUTHOR]

L'objectif de cet article est de préciser les spécificités de l'approche psychanalytique du traumatisme, à partir de l'étude d'un cas clinique unique. Là où les discours contemporains tendent à souligner le rôle des évènements vécus dans la survenue d'un tableau psychopathologique, nous chercherons à montrer comment la psychanalyse opère un décentrement vis-à-vis des modèles explicatifs déterministes et linéaires. Â partir du cas d'un patient psychotique d'une cinquantaine d'années ayant perdu la vue suite à une blessure par arme à feu, nous montrerons comment la psychanalyse propose de mettre l'accent non pas intrinsèquement sur l'évènement passé, mais sur la réponse singulière et toujours imprévisible du sujet, dans une perspective diachronique prenant en compte l'importance de la temporalité et de l'après-coup. Nous pourrons ainsi étudier comment chez ce patient, l'évènement traumatique est progressivement réintégré dans une construction subjective singulière, et nous tenterons d'appréhender les ressorts stabilisateurs de cette construction au prisme de l'hypothèse freudienne du délire comme « tentative de guérison ». La méthode que nous avons adoptée est celle de l'étude d'un cas unique, dans la mesure où elle est la seule à pouvoir rendre compte de la singularité de la réponse du sujet dans son caractère diachronique. Il s'agira en particulier d'assumer le style d'une écriture analytique du cas qui s'écarte de tout idéal d'objectivité scientifique, puisque la technique psychanalytique se caractérise par la place majeure accordée à la dimension transférentielle dans la cure, et engage de fait la subjectivité du thérapeute. Nous nous efforcerons ainsi de restituer l'histoire de ce patient dans son déploiement temporel, en relatant les éléments biographiques et anamnestique tels qu'ils sont apparus au travers de la rencontre clinique, en y intégrant également des éléments issus de la consultation d'archives des dossiers médicaux. Nous étudierons ensuite l'évolution de sa position subjective au prisme des développements freudiens et lacaniens sur la psychose. Une approche psychanalytique a permis de mettre en évidence que, chez ce patient, sa position d'objet d'un préjudice est antérieure à la survenue de son agression par arme à feu. Cet évènement sera ainsi dans un premier temps réintégré par le sujet dans le cadre de la logique du délire de persécution qui le précède. Néanmoins, la reconnaissance sociale de sa position de victime a pu induire chez lui un effet pacificateur, et il réinterprètera dans un second temps cet évènement à partir de la construction d'une position d'exception, par l'incarnation de la figure du « voyant », qui viendra jouer un rôle de nomination et conduira à l'apaisement significatif des angoisses de persécution. Au-delà de l'hypothèse d'une « déduction logique » de la mégalomanie à partir des idées délirantes de persécution en vigueur dans la psychiatrie classique, la théorie freudienne et lacanienne permettent de situer les ressorts de cette position d'exception relativement à l'économie libidinale du sujet. Nous proposerons de discuter des similitudes existant entre la position d'exception construite par ce patient et deux cas célèbres de la littérature psychanalytique : le Président Schreber, auteur des Mémoires d'un névropathe , et l'écrivain irlandais James Joyce. Il s'agira en particulier de montrer que la construction délirante de notre patient diffère de la logique du « pousse-à-la-femme » à l'œuvre chez Schreber, et qu'elle n'est pas analogue non plus à la production d'un sinthome borroméen. En effet, sa construction délirante (contrairement à l'œuvre produite par Joyce) ne permet pas de le réinscrire dans une forme de lien social. Néanmoins, le travail thérapeutique réalisé avec ce patient lors de sa dernière hospitalisation permet de préciser comment la relation transférentielle peut dans certains cas permettre au patient psychotique de se saisir du thérapeute comme d'un partenaire qui viendrait authentifier l'advenue d'une position d'énonciation, ainsi que la production d'une nomination par le travail du délire. La méthode du cas unique permet de mettre en évidence que l'approche psychanalytique du traumatisme opère un décentrement vis-à-vis de toute perspective tendant à faire de l'évènement traumatique le ressort causal du tableau psychopathologique. L'abord de l'histoire du patient dans sa globalité et sa complexité permet ainsi au contraire de mettre l'accent sur la réponse unique et imprévisible du sujet. La logique temporelle de l'après-coup freudien implique en effet de reconsidérer dans une perspective dynamique et diachronique la rencontre entre le sujet et l'évènement, en prenant en compte le déjà-là de la structure, l'histoire singulière du sujet, mais aussi les potentialités créatrices et imprévisibles de chacun – la relation thérapeutique pouvant apparaître comme une quatrième dimension lorsqu'elle vient offrir un support à cette création subjective et l'accompagne. The objective of this article is to clarify the specificities of the psychoanalytic approach to trauma, based on the study of a single clinical case. Whereas contemporary discourses tend to emphasize the role of lived events in the emergence of a psychopathological picture, we aim to demonstrate how psychoanalysis operates a shift in perspective vis-à-vis deterministic and linear explanatory models. Focusing on the case of a psychotic patient in his fifties who had lost his sight following a gunshot wound, we demonstrate how psychoanalysis invites us not to place the emphasis intrinsically on a past event. Rather, it suggests looking at the singular and unpredictable response of the subject as an individual, in a diachronic perspective that takes into account the importance of temporality and hindsight. In this way, I was able to study how this patient gradually integrated the traumatic event into a singular subjective construct. In turn, this allowed me to understand the stabilizing mechanisms of this construct, through the prism of the Freudian hypothesis of delusion as an "attempt at healing". The method I adopted is that of the single case study. This approach was chosen as it is the only one that can illustrate the singularity of the subject's response in its diachronic character. In particular, I deliberately chose the style of an analytical case study. This differs from the ideal of scientific objectivity insofar as the psychoanalytic technique is characterized by the importance given to the transferential dimension in the cure, and thus calls upon the subjectivity of the therapist. Thus, I endeavored to reconstruct the history of this patient in its diachronic unfolding, by recounting the biographical and anamnestic elements as they appeared during the clinical encounter. To support this further, I integrated elements from the archival consultation of medical records. I then studied the evolution of the patient's subjective position through the prism of Freudian and Lacanian theories on psychosis. A psychoanalytic approach made it possible to demonstrate that in this patient, his position as the object of an injury predated the occurrence of his wounding by firearm. This later event was thus initially reintegrated, by him, within the framework of the logic of the delusion of persecution that predated it. Nevertheless, the social recognition of his position as a victim may have induced in him a pacifying effect. He was able to reinterpret the event in the aftermath, based on the construct of a position of exception. In that position, he assumed the figure of the 'seer' who played the role of naming, leading to a significant appeasement of the persecution anxieties. Here I propose a discussion of the possible similarities between the position of exception constructed by this patient, and the cases of President Schreber and the writer James Joyce. In particular, my aim was to show that the delusional construction of my patient differed from the logic of the 'pousse-à-la-femme,' and that it was also not analogous to the production of a Borromean sinthome. This was because his delusional construct did not enable his re-inscription into any form of social bond. Nevertheless, the therapeutic work carried out with this patient during his last hospitalization made it possible to pinpoint how the transferential relationship can, in some cases, help the psychotic patient to make use of the therapist as a partner. Such a partner authenticates the advent of a position of enunciation, and the action of naming through the process of delusion. The single case method made it possible to demonstrate that the psychoanalytic approach to trauma offsets any tendency to make the traumatic event the causal root of the psychopathological picture. By looking at the patient's history in its entirety and its complexity, it was possible to emphasize the unique and unpredictable nature of the subject's response. The temporal logic of Freudian hindsight calls for a re-evaluation of the encounter between the subject and the event from a dynamic and diachronic perspective. Such a re-evaluation takes into account structures that are already in place, the singularity of the subject's history, as well as the unpredictable creative potential of each individual. In addition, the therapeutic relationship may form a fourth aspect, when it becomes a support and accompaniment to the subjective creation. [ABSTRACT FROM AUTHOR]

La psychothérapie institutionnelle reste un courant important pour quiconque travaille à l'hôpital ou en institution avec des patients souffrants de problématiques psychiatriques. Jean Oury en est le personnage principal et il a toujours défendu que toutes les idées et notions de la psychothérapie institutionnelle ne pouvaient se penser qu'en articulation avec une pratique au quotidien centrée sur la psychose de manière générale et sur la schizophrénie de manière particulière. Il nous a semblé dès lors intéressant de tenter de résumer la définition et la conception qu'Oury se faisait de la psychose et de la schizophrénie. C'est un travail dont la valeur est relative : Oury n'a jamais voulu faire un cours magistral sur le sujet et il refusait le discours universitaire. Son style et son enseignement principalement oral ne se prêtent pas à un résumé un peu scolaire. Néanmoins, il nous a semblé que l'exercice en valait la peine. En se basant sur de nombreuses citations, nous avons voulu synthétiser la position de Jean Oury. La nosologie sur laquelle s'appuie Oury est empruntée à la psychiatrie classique et n'est, à notre avis, pas la plus adéquate pour une clinique qui préconise l'accueil et la rencontre. Pour l'avenir de la psychothérapie institutionnelle, il est sans doute important de dissocier toutes les recommandations du mouvement pour soigner l'institution de la nosologie sur laquelle elles s'étayent. Seule la psychothérapie institutionnelle nous a appris à tenter de soigner les institutions de soins et à lutter contre la tendance naturelle de ces endroits à la ségrégation et aux rapports de force soignants-soignés. Mais une clinique de l'accueil et de la rencontre mérite mieux qu'une nosologie empruntée à la psychiatrie classique. Institutional psychotherapy remains an important current of thought for anyone working in hospitals or in institutions with patients suffering from psychiatric problems. Jean Oury is the main figure of this current and he always maintained that all the ideas and notions of institutional psychotherapy could only be thought of in conjunction with a daily practice centered on psychosis in general and on schizophrenia in particular. It therefore seemed interesting to us to try to summarize Oury's definition and conception of psychosis and schizophrenia. The value of our contribution is relative: Oury never wanted to give lectures on the subject and he refused the academic discourse. His style and his mainly oral teaching do not lend itself to a somewhat academic summary. Nevertheless, it seemed to us that the exercise was worth it. Based on numerous quotations, we wanted to synthesize Jean Oury's position. The nosology on which Oury relies is borrowed from classical psychiatry and is, in our opinion, not the most appropriate for a clinical practice that advocates reception and encounter. For the future of institutional psychotherapy, it is undoubtedly important to dissociate all the recommendations of the movement to heal the institution from the nosology on which they are based. Only institutional psychotherapy has taught us to try to heal care institutions and to fight against the natural tendency of these places to segregation and caregiver-patient power relations. But a clinical practice of reception and encounter deserves better than a nosology borrowed from classical psychiatry. [ABSTRACT FROM AUTHOR]

In this article, we propose a reflection on the place of spontaneous creation in the therapeutic care of adolescents presenting a first episode of psychotic decompensation. Based on the clinical case of Emilio, 13 years old, and the examination of the productions produced during interviews, the act of creation is considered as a self-therapeutic attempt to adapt the world. The theoretical-clinical analysis of the transferential productions and positioning of the subject points to the possibility of emergence, at the initiative of the adolescent, of a place of address allowing this passage from an almost delusional private scenario to an authentic creation addressed to another becoming a witness to the authorship of the creation initiated by the subject. Therefore, the act of creation as addressed can be thought of as a possible compensatory elaboration coming to mask the deleterious effects of the lack of symbolic inscription of the psychotic adolescent. The act of compensatory creation, by generating a possible identity, even purely functional and stereotypical, for the subject thus allows the psychotic adolescent to once again enter into a bond with the other in a more peaceful manner. [ABSTRACT FROM AUTHOR]

L'article vise à soutenir une conception métapsychologique permettant de critiquer le modèle déficitaire de la psychose en psychiatrie. Cette critique visant l'héritage de la pensée kraepelinienne et passant par la discussion des apports d'E. Bleuler et H. Ey s'articule autour de la distinction entre les notions de « déficit » et de « défaut ». À partir d'un cas issu de sa clinique au sein d'une unité d'accueil familial thérapeutique pour adultes psychotiques, l'auteure revient à la théorie des psychoses dissociatives à partir du « travailler » et du « travail vivant » de ceux qui prennent soin de ces malades. En mobilisant la théorie laplanchienne de la genèse de la pensée et la topique du clivage de Christophe Dejours, l'auteure soutient l'idée que ce qui caractérise la psychose dissociative n'est pas le déficit mais l'inhibition. Cette inhibition touche les fonctions affectives et perceptives du corps. Elle représente une modalité défensive ne découlant pas d'un traumatisme mais d'un défaut de construction du corps érotique entraînant une économie pulsionnelle singulière appelée disruptive. Ce défaut de construction n'est pas irréversible mais le traitement thérapeutique de ces patients nécessite–condition sine qua non –la mobilisation du corps érotique des soignants pour la mise au travail de soi sur soi du patient. The article proposes a metapsychological conception allowing us to criticize the deficit model of psychosis in psychiatry. This criticism of the Kraepelinian heritage, through the discussion of the contributions of E. Bleuler and H. Ey, revolves around the distinction between the notions of "deficit" and "default." From a case extracted from her clinical experience in a therapeutic foster care unit for psychotic adults, the author returns to the theory of dissociative psychosis from the "work" and "living work" of those who care for these patients. By mobilizing the Laplanchian theory of the genesis of thought and Christophe Dejours's topography of splitting, the author maintains that what characterizes dissociative psychosis is not deficit but inhibition. This inhibition affects the emotional and perceptual functions of the body. It represents a defensive modality not resulting from a trauma but from a defect in the construction of the erotic body leading to a singular instinctual economy, labeled disruptive. This construction defect is not irreversible, but the therapeutic treatment of these patients requires–a sine qua non condition–the mobilization of the erotic body of the caregivers, in order for the patient to begin their own self-work. [ABSTRACT FROM AUTHOR]

Nous explorons dans cet article les liens entre les événements de vie adverses survenus durant l'enfance (ACE) et la commission de certains types d'homicide(s) : infanticide, filicide, uxoricide, matricide, patricide, parricide, fratricide, aviolicide, double homicide, tueries de masse, meurtres en série, etc. Les dossiers « patients » de 442 auteurs d'homicide(s) de sexe masculin hospitalisés en Unité pour Malades Difficiles (UMD) entre 1963 et 2020 ont, pour ce faire, été examinés. Une grille de récolte thématique fut spécialement élaborée en vue de reconstruire les trajectoires traumatogènes des sujets concernés, et ainsi statuer sur la présence ou l'absence de différentes formes d'ACE (violences physiques, émotionnelles et sexuelles, négligences physiques et affectives, exposition répétée à de la violence conjugale, etc.). Aux données de prévalence d'abord restituées succèdent des analyses des correspondances multiples (ACM). Celles-ci visent à faire émerger des patterns d'associations reliant tel(s) ou tel(s) ACE aux types d'homicide(s) investigués. La projection des résultats au sein d'un espace multidimensionnel nous permettra de visualiser les principaux rapprochements qu'il semble permis d'opérer, à des fins cliniques et préventives, ou tout simplement descriptives. Des classifications ascendantes hiérarchiques (CAH) sont ensuite réalisées, de façon à regrouper les individus en classes latentes distinctes, découpées et constituées selon les similarités et les dissimilitudes des homicidaires ici étudiés (spécifiquement considérés, donc, à l'aune des éléments d'adversité ayant jalonné leur parcours de vie). Les profils esquissés sont alors discutés, tout comme les taux particulièrement élevés d'ACE globalement relevés – notamment en comparaison à ce qui a pu être observé dans d'autres échantillons (en population générale, carcérale ou médico-légale). Des perspectives de recherches ultérieures sont pour finir formulées, sur la base des limites inhérentes à la méthodologie présentement employée. In this article, we explore the links between adverse childhood experiences (ACEs) and the commission of certain types of homicide(s): infanticide, filicide, uxoricide, matricide, patricide, parricide, fratricide, aviolicide, double homicide, mass killings, serial murders, and so on. The patient files of 423 male perpetrators of homicide(s) hospitalized in a French secure forensic psychiatric unit between 1963 and 2020 were examined. A thematic collection grid was specially designed to reconstruct the traumatogenic trajectories of the subjects concerned, and to thereby determine the presence or absence of different forms of ACE (physical, emotional, and sexual violence, physical and emotional neglect, exposure to domestic abuse and conjugal violence, etc.). After calculating prevalence data, multiple correspondence analyses (MCA) were performed, in order to identify patterns of association linking specific ACEs to the types of homicide investigated. Projection of the results within a multidimensional space will enable us to visualize the main associations that may be established for clinical and preventive purposes. Agglomerative hierarchical clustering (AHC) is then used to group individuals into distinct latent classes, based on the similarities and dissimilarities of the homicidal criminals studied. The profiles outlined are then discussed, as are the particularly high rates of ACEs found – especially in comparison with data obtained from other studies (carried out in general, prison or forensic populations). Finally, we suggest a few avenues for future research. [ABSTRACT FROM AUTHOR]

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]

In this letter to the editor, we respond to the article by Dodier, Lynn and Otgaar entitled " Analyse critique des mythes sur les troubles dissociatifs de l'identité " ("A Critical Analysis of the Myths about Dissociative Identity Disorders"). Their article presents a critique of our article published in French in the same journal entitled " Trouble dissociatif de l'identité : les mythes à l'épreuve des recherches scientifiques " ("Dissociative Identity Disorders: Myths Put to the Test by Scientific Research") [11]. Our article reviews several beliefs about dissociative identity disorders that are widespread in the French-speaking clinical field. The criticisms of Dodier et al. are used to present their socio-cognitive model of dissociation. We take up their criticisms and develop various arguments to conclude with the observation that there are many areas of agreement. Nevertheless, conceptual and clinical aspects make it difficult to further reconcile them. We conclude that there is an urgent need for research in the field of dissociative identity disorders. [ABSTRACT FROM AUTHOR]

Education was apparently of central importance to Manès Sperber from an early age and remained significant throughout his life. From the experience of his Hasidic upbringing, he retained the idea of learning as a high value, whereby he understood it to be a thoughtful and examining approach to whatever should be the subject of the learning process. Structural multiperspectivity and the ideal of a demanding and supportive teacher played no small role and probably made it easier for Sperber to gain personal access to Alfred Adler and his Individual Psychology. From this he took the concept of self-education and made it useful for himself. His primary approach to psychotherapy was that of a social pedagogue, which at the same time could accommodate the possibilities of therapeutic thinking in larger contexts, because not only the pathology of the patient, but also the setting in which he acted, could be taken into account. [ABSTRACT FROM AUTHOR]

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In claiming to shed new light on madness that is psychosis, existential analysis (Daseinsanalyse) comes up against a fundamental methodological objection: is it phenomenologically possible to penetrate and describe the world of madness? In other words, if we recognize the gap of mutual incomprehension that separates psychotics and non-psychotics, should we not give up the Husserlian path of exploration of madness, based on transcendental reflexion? But in this case, is a phenomenology of psychoses still possible and how? [ABSTRACT FROM AUTHOR]

Traumatisme et psychose sont depuis longtemps liés dans la littérature psychiatrique, bien qu'aucune relation de cause à effet n'ait pu être établie. En effet, la pratique clinique quotidienne confronte psychiatres et psychologues à des configurations psychopathologiques dans lesquelles la distinction entre états post-traumatiques et symptômes psychotiques s'avère peu claire, et génère des doutes quant au diagnostic et au devenir des jeunes traités. Après avoir établi une revue de la littérature à propos des interactions entre expériences traumatiques/traumatogènes et symptômes de type psychotique, nous nous appuierons sur cinq études de cas d'adolescents ayant une histoire de vie traumatique et hospitalisés pour des troubles aigus ou subaigus de type psychotique. Notre méthodologie d'analyse sera qualitative, afin de mieux articuler les points d'incertitude et les éléments de diagnostic différentiel entre des troubles psychotiques brefs liés à des traumatismes complexes, et la décompensation potentielle d'un trouble psychotique plus chronique, par exemple la schizophrénie. Ces éléments pourront aider le clinicien à distinguer des ensembles cliniques en apparence similaires, afin d'orienter la prise en charge et d'éviter l'aggravation de ces troubles à l'âge adulte. Dans le cas de traumatismes extrêmes, nous proposons de ne pas nous focaliser sur la recherche de symptômes prépsychotiques dans le cadre d'une potentielle décompensation d'une psychose chronique, et de considérer davantage les délires et hallucinations comme des symptômes transitoires à l'adolescence, qui permettent de faire face à des événements de vie traumatiques. Au-delà de la question de la nature des symptômes, nous évoquerons le type de prise en charge de ces jeunes, dont l'avenir dépend d'un diagnostic précis et non stigmatisant. In psychiatric studies, trauma and psychosis have long been linked, although researchers have not been able to establish a unilateral cause-and-effect relationship. While clinical research in psychiatry has focused on the prevention of psychotic decompensation, and even on the identification of pre-psychotic states in adolescents – not without caution, however, due to the stigma associated with the diagnosis of psychotic pathologies –, in the everyday clinical practice psychiatrists and psychologists are faced with psychopathological configurations in which the distinction between post-traumatic states and psychotic symptoms proves to be equivocal. This results in doubts as to the diagnosis and the future of the young people who are treated for such disorders. The difference between hallucinations and reliving a traumatic experience, for example, can mislead the clinician about the subjective structure of the adolescent and thus contribute to a very marked orientation of the treatment either towards subjective reconstruction based on the damage induced by the traumatic events, or towards the avoidance of possible psychotic decompensation. After conducting an overview of the scientific literature on the interactions between traumatic/traumatogenic experiences and psychotic-type symptoms, we will consider five case studies of adolescents with traumatic life histories and who have been hospitalized for acute or subacute psychotic-like disorders. The methodology for our analyses will be qualitative, so that it can help the clinician to distinguish between apparently similar clinical ensembles, and in order to better articulate the points of uncertainty and the elements of differential diagnosis between brief psychotic disorders related to complex traumas and the potential decompensation of a more chronic psychotic disorder, e.g., schizophrenia. In the case of complex traumas, we propose to shift the focus away from a search for pre-psychotic symptoms in order to prevent the decompensation of a supposed chronic psychosis, and to consider instead the delusions and hallucinations experienced by these subjects as transitory symptoms in adolescence, which are extreme defense mechanisms against traumatic life events. Beyond the question of the endogenous or exogenous nature of the symptoms, we will discuss the type of care provided to these young people, in order to adapt the treatment and avoid making these disorders worse during adulthood. The future of these young people depends on an accurate and non-stigmatizing diagnosis. [ABSTRACT FROM AUTHOR]

Hintergrund: In aktuellen deutschsprachigen Leitlinien zur Behandlung von Menschen mit Schizophrenie wird für kognitive Verhaltenstherapie (KVT) die höchste Evidenzstufe angegeben. Jedoch weist vergangene Forschung darauf hin, dass nur ein geringer Teil eine entsprechende Behandlung erhält. Methode: Um Zugangsbarrieren für Menschen mit psychotischen Störungen vonseiten der Psychotherapeut_innen zu identifizieren, wurden in der vorliegenden Studie 215 Psychotherapeut_innen in einer Online-Umfrage unter anderem nach ihren Einschätzungen zur Indikation und Schwierigkeiten in der Bewilligung einer Psychotherapie, ihrer Ausbildung hinsichtlich psychotischer Störungen so-wie Vorschlägen zur Verbesserung der Zugänglichkeit von Psychotherapie für Menschen mit Psychose befragt. Ergebnisse: Als größtes Hindernis wurde unzureichende Ausbildung hinsichtlich der Behandlung von psychotischen Störungen berichtet. Jedoch wird die Bewilligung einer Psychotherapie von einigen Befragten als erschwert eingeschätzt. Diskussion: Die zentralen Verbesserungen, einschließlich aktueller symptomspezifischer KVT-basierter Ansätze zu Wahn oder Halluzinationen, werden als Perspektive zur gezielten Weiterbildung diskutiert. [ABSTRACT FROM AUTHOR]

Le harcèlement en milieu scolaire (bullying) durant l'enfance et l'adolescence est un problème de santé publique. L'état à haut risque de psychose (UHR) est associé à une prévalence plus importante de harcèlement scolaire en comparaison avec les sujets contrôles. Nous nous sommes proposés de résumer les résultats des études existantes en vue de comprendre les mécanismes reliant harcèlement scolaire et état UHR, leurs spécificités cliniques et évolutives, ainsi que leurs implications interventionnelles. Le type de harcèlement scolaire subi au cours de l'enfance et de l'adolescence est associé à la nature des symptômes psychotiques subcliniques qui apparaissent plus tard au cours de la vie. Le développement de symptômes psychotiques chez les victimes de harcèlement scolaire dans l'enfance semble être lié à la fréquence, à la gravité et à la durée de la victimisation. Des preuves limitées suggèrent que la cessation du harcèlement scolaire pourrait prévenir l'apparition des symptômes psychotiques ou d'un état à risque de psychose. Plusieurs modèles explicatifs du lien entre harcèlement scolaire et survenue ultérieure de psychose ou d'états prépsychotiques ont été avancés dans la littérature, notamment les anomalies développementales prémorbides, la qualité de l'attachement, les schémas cognitifs dysfonctionnels et théorie de l'esprit, et les anomalies de l'axe hypothalamo-hypophysaire. Malgré le nombre limité de preuves, un dépistage de l'existence d'une victimisation antérieure lors de l'évaluation initiale des sujets UHR et leur prise en charge adéquate semblent justifiés. Toutefois, aucune étude n'a évalué à ce jour des protocoles d'intervention spécifiques pour la prise en charge du harcèlement scolaire chez les sujets UHR. Bullying in schools during childhood and adolescence is a growing public health problem due to its high prevalence worldwide and its various negative impacts on mental health. Evidence suggests that the "ultra-high risk for psychosis" (UHR) state is associated with a higher prevalence of bullying compared to the control subjects. We proposed to summarize the results of existing studies to provide a more thorough understanding of the mechanisms linking bullying and an UHR state, their clinical and evolutionary specificities, as well as their interventional implications. PubMed and Medline search, Scopus, journal and textbook articles have been consulted for the review of literature on the relationship between bullying and psychosis in UHR subjects. We found that the type of bullying experienced during childhood and adolescence may be related to the nature of subclinical psychotic symptoms experienced later. The development of psychotic symptoms in victims of bullying appears to be related to the frequency, severity, and duration of victimization. Limited evidence suggests that stopping bullying may prevent the onset of psychotic symptoms or an UHR state. Several explanatory models of the link between bullying and the subsequent onset of psychosis or prepsychotic states have been advanced in the literature, including premorbid developmental abnormalities, quality of attachment, dysfunctional cognitive patterns and theory of mind, and hypothalamic-pituitary axis abnormalities. Despite the limited body of evidence, screening for the existence of prior victimization during the initial assessment of UHR subjects and their adequate management seem to be justified. However, to date, no study has evaluated specific intervention protocols for the management of bullying in UHR subjects. [ABSTRACT FROM AUTHOR]

Les auteurs, cliniciens et chercheurs en psychopathologie, développent un phénomène psychique transtructurel rencontré chez des patients obèses opérés d’une chirurgie bariatrique: des fantasmes et des délires de morcellement corporel. C’est à partir d’un cas clinique de névrose et un autre de psychose, que l’impact psychique de la chirurgie bariatrique sera étudié, avec la mise en lumière d’une altération de l’image du corps et de ses sensations qui serait à l’origine de ce phénomène de morcellement.

In this paper I would like to examine - from a psychoanalytical point of view - the pathological functioning characterized by the sensory excess in the mind which seems to constitute a fundamental component in psychosis. Starting from the observation of this specific topic in clinical experience with psychotic patients, I would like to illustrate some psychoanalytic assumputions on the genesis and progression of the psychotic state, evaluating its clinical and psychopathological implications. Bion's theory of thought and conceptualization on the invasion of the healthy part of the patient by the psychotic part - imbued with pathological sensoriality and which transforms the perception of psychic reality - is a main point in this paper (Bion, 1957). Some contemporary authors ideas on psychosis and neuroscientific evidence seems to converge on the significance of this subject. [ABSTRACT FROM AUTHOR]

On Friday 13 February 1976, during the discussion of his clinical presentation of Gérard L., Lacan proposes the diagnosis of ‘Lacanian psychosis’ and develops this point in his seminar The sinthome on the following Tuesday, 17 February 1976. He makes this diagnosis again in his clinical presentation on Friday 5 November 1976. What’s it about?. [ABSTRACT FROM AUTHOR]

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L'afflux important de demandeurs d'asile confronte la psychiatrie publique à des souffrances découlant de violences politiques extrêmes. Parmi ces patients, les survivants de l'expérience de la torture présentent une sémiologie singulière, à laquelle il convient d'être sensibilisé. Si certains chercheurs proposent des concepts éclairants, les mots des témoins et des écrivains constituent le point d'articulation entre la théorie et la pratique. Dans ce propos, on tentera de comprendre en quoi la torture est un laboratoire de fabrication de la psychose, notamment par le rôle spécifique et ambigu que joue le champ de l'imaginaire. Un développement sera ensuite dédié aux processus d'humiliation, qui mettent en lumière une dialectique entre le corps et l'esprit, entre les séquelles corporelles et les tenaces blessures d'âmes ; la torture occasionnant, de façon intentionnelle, un risque de fracture entre le Moi et l'Idéal du moi. Nous tenterons également d'interroger notre rôle thérapeutique, afin que celui-ci soutienne une issue favorable à la conflictualité pathogène à l'œuvre. The large influx of asylum seekers confronts public mental health services with the suffering resulting from extreme political violence. Among these patients, survivors of torture present a unique clinical profile of which clinicians should be made aware. While certain researchers have proposed useful concepts, the statements of witnesses and the writings of clinicians constitute the point of articulation between theory and practice. In this article, we will attempt to understand the ways in which torture results in psychosis ("a laboratory of psychosis"), notably through the specific and ambiguous role of the imaginary. A specific focus will be dedicated to the processes of humiliation, which illuminate a dialectic between the body and the mind, between the physical wounds and the long-lasting injuries inflicted on the soul; torture causing, intentionally, the possibility of a rupture between the ego and the ideal of the self. Finally, the article will critically examine the role of the therapist; so that clinicians will be able find a favorable resolution to the pathogenic conflicts involved. [ABSTRACT FROM AUTHOR]

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Il est admis que les processus psychologiques et neuropsychologiques jouent un rôle dans l'apparition et le maintien des symptômes psychotique positifs. Le sentiment de persécution et les délires sont le résultat de processus dont le contexte de vie de la personne joue un rôle important dans la génération du sentiment de menace. Le maintien de cet état est ensuite favorisé par des facteurs que l'on peut regrouper en deux types selon leur objet. Dans un premier temps, l'obtention de preuves de confirmation est privilégiée par le délire lui-même. De plus, les preuves contradictoires sont mises de côté. Sur le plan neuropsychologique, la saillance aberrante pour les stimuli neutres est due à une libération excessive de dopamine qui sous-tend les symptômes positifs, l'enclenchement et le maintien de l'ensemble de ces symptômes. On repère également chez ces patients des déficits attentionnels, des défauts d'inhibition, de fonction exécutive et de cognition sociale. Cette brève revue de la littérature met en avant l'importance de procéder, le plus rapidement possible, à une évaluation complète des processus psychologiques et neuropsychologiques, car des déficits tendent à rendre plus vulnérable au maintien de symptômes psychotiques (positif et négatifs), entraînant un impact fonctionnel délétère. It is recognized that psychological and neuropsychological processes play a role in the development and maintenance of positive psychotic symptoms. The sense of persecution and delusions are the result of processes in which the context of the person's life plays an important role in producing a feeling of being threatened. The maintenance of this state is favored by factors that can be grouped into two types according to their purpose. Firstly, obtaining confirmatory evidence is favored by the delusion itself. Secondly, contradictory evidence is set aside. Neuropsychologically, the aberrant salience for neutral stimuli is due to an excessive production of dopamine that underlies the positive symptoms. Attentional deficits, inhibition, executive function and social cognition are also present in these patients. This brief review of the literature highlights the importance of conducting a comprehensive assessment of psychological and neuropsychological processes as soon as possible, as deficits tend to make one more vulnerable to the perpetuation of more significant psychotic symptoms (both positive and negative) with a deleterious functional impact. [ABSTRACT FROM AUTHOR]

In this letter to the editor, we respond to the article by Dodier, Lynn and Otgaar entitled " Analyse critique des mythes sur les troubles dissociatifs de l'identité " ("A Critical Analysis Of The Myths About Dissociative Identity Disorders"). Their article presents a critique of our article published in French in the same journal entitled " Trouble dissociatif de l'identité: les mythes à l'épreuve des recherches scientifiques " ("Dissociative Identity Disorders: Myths Put To The Test By Scientific Research") [11]. Our article reviews several beliefs about dissociative identity disorders that are widespread in the French-speaking clinical field. The criticisms of Dodier et al. are used to present their socio-cognitive model of dissociation. We take up their criticisms and develop various arguments to conclude with the observation that there are many areas of agreement. Nevertheless, conceptual and clinical aspects make it difficult to further reconcile them. We conclude that there is an urgent need for research in the field of dissociative identity disorders. [ABSTRACT FROM AUTHOR]

En opposition à la « psychose », on parlait dans les classifications encore en vogue il y a moins d'une décennie de « névroses traumatiques ». Un texte juridique important affirme encore aujourd'hui, dans notre pays, que « les psychoses post-traumatiques n'existent pas », ce qui empêche leur indemnisation au titre de la réparation du dommage psychique. Et pourtant, battant ces dogmes en brèche, certains praticiens ont itérativement rendu compte de situations cliniques où traumatisme psychique et psychose se découvrent intimement liés. Les enjeux thérapeutiques et médico-légaux sont majeurs, de même que les implications en termes de recherche. D'après une revue de la littérature internationale confrontée à notre expérience pratique, nous définissons les différentes typologies anatomocliniques de psychoses post-traumatiques. Nous exposons successivement les psychoses induites par : (i) un traumatisme psychique isolé en subdivisant les troubles fonctionnels (aigus et chroniques) et structurels (schizophréniques et paranoïaques); (ii) un traumatisme crânien isolé avec présentation des symptômes en fonction de l'étendue des lésions cérébrales (troubles psychotiques organiques, schizophrenia-like psychosis , schizophrénique post-traumatique). La très récente densification de la description clinique des troubles psychiques post-traumatiques a mis en évidence la notion de psychoses post-traumatiques. Pourtant, si certains barèmes médico-légaux évoquent ces troubles, c'est parfois paradoxalement pour en récuser l'existence ou l'imputabilité, sans d'ailleurs forcément préciser si le fait en cause constitue un trauma psychique ou un trauma crânien, lesquels peuvent en pratique s'intriquer. En réalité, les liens séméiologiques et étiopathogéniques entre traumas et psychoses sont complexes, souvent bidirectionnels, sans que l'imputabilité des symptômes résultants soit à récuser pour autant, au contraire le plus souvent. In opposition to "psychosis", one spoke in the classifications still in vogue less than a decade ago of "traumatic neuroses". An important legal text still affirms today, in our country, that "post-traumatic psychosis does not exist", which prevents their compensation under the reparation of psychic damage. But defeating these dogmas in breach, clinicians have repeatedly reported on situations where psychological trauma and psychosis are found to be intimately linked. The therapeutic and medico-legal issues are major, as are the implications in terms of research. Based on a review of the international literature compared to our practical experience, we define the different anatomoclinical typologies of post-traumatic psychosis. We successively present the psychoses induced by: (i) an isolated psychic trauma by subdividing the functional (acute and chronic) and structural (schizophrenic and paranoid) disorders; (ii) an isolated traumatic brain injury with presentation of symptoms according to the extent of the brain lesions (organic psychotic disorders, schizophrenia-like psychosis, post-traumatic schizophrenia). The very recent densification of the clinical description of post-traumatic mental disorders has highlighted the notion of post-traumatic psychosis. However, if certain medico-legal scales mention these disorders, it is sometimes paradoxically to deny their existence or their imputability (without necessarily specifying whether the fact in question constitutes a psychic or cranial trauma). In reality, the semiological and etiopathogenic links between trauma and psychosis are complex, often bidirectional, without the medico-legal attribution of the resulting symptoms having to be challenged, on the contrary most often. [ABSTRACT FROM AUTHOR]

La Covid 19 est apparue comme l’une des pandémies les plus virulentes de l’histoire de l’humanité. Comme « une temporalité de surprise », elle s’est érigée en maître. Elle a aussi fait naitre une peur et a entrainé une psychose sans précédent auprès des populations. Au Sénégal, son apparition a amené l’État à prendre plusieurs mesures sanitaires qui ont engendré des répercussions dans le vécu quotidien et collectif de la population. Son traitement médiatique a mobilisé tous les segments de la société. Entre état d’urgence, mesure sanitaire, couvre-feu, les séquelles de cette maladie ont amené à une modification des habitudes quotidiennes de la population sénégalaise. Ce texte est le fruit de réflexions d’un confiné errant. Il décrit et analyse à la fois les mesures sanitaires prises par l’État du Sénégal face à la Covid 19, les discours « covidiaires » nés de cette situation, le vécu quotidien d’un confiné ainsi que les leçons que nous pouvons tirer d’un contexte marqué par la peur et la psychose et nous amène à réfléchir sur le traitement médiatique autour de cette maladie dans le dénouement de ce pêle-mêle.

Il s'agit d'interroger les conséquences de l'apparition de la notion de spectre de l'autisme, introduite dans le DSM-5, quant au risque de conduire à une extension abusive de ce diagnostic. Des constats cliniques croissants de diagnostics d'autisme erronés trouvent confirmation dans des études épidémiologiques. Il apparaît que les outils diagnostiques de l'autisme ont évolué dans le sens d'un nivellement vers le bas, de sorte que la différence entre une personne diagnostiquée autiste et un individu a priori « neurotypique » s'est considérablement réduite. Les critères de l'autisme semblent s'être élargis jusqu'à des formes atténuées qui conduisent à confondre autisme et traits autistiques. Le diagnostic d'autisme est devenu attractif et valorisant. Les réseaux sociaux et les médias contribuent à son extension. La pertinence de son autodiagnostic est revendiquée par certains sans envisager les difficultés qu'il soulève. La place très réduite accordée à la schizophrénie infantile dans le DSM-5 ne conduit-elle pas à une inclusion abusive de la psychose infantile dans l'autisme ? En ce qui concerne les adultes le manque de repérage des psychoses ordinaires n'est-il pas un facteur d'extension de l'autisme ? L'inflation actuelle de l'autisme incite à un retour à la clinique, c'est-à-dire à une approche qui privilégie la relation à l'autre plutôt que l'exercice d'outils scientifiques. To question the consequences of the appearance of the notion of Autism Spectrum Disorder, introduced in the DSM-5, with regards to the risk of an abusive extension of this diagnosis. Increasing clinical findings of misdiagnosis of autism are confirmed in epidemiological studies. It appears that the diagnostic tools for autism have evolved in the direction of a decrease in specificity, so that the difference between a person diagnosed with autism and an a priori "neurotypical" individual has been considerably reduced. The criteria for autism seem to have broadened to attenuated forms that lead to confusing autism with autistic traits. The diagnosis of autism has become attractive and rewarding. Social networks and the media contribute to its extension. Some people proclaim the relevance of self-diagnosis, without considering the difficulties it raises. Doesn't the very limited place given to childhood schizophrenia in the DSM-5 lead to an abusive inclusion of childhood psychosis in autism? As far as adults are concerned, isn't the lack of identification of ordinary psychoses a factor of the contemporary extension of autism diagnoses? The current inflation of autism encourages a return to the clinical approach, that is: to an approach that relies on the relation to the other rather than the utilization of scientific tools. [ABSTRACT FROM AUTHOR]

C.G. Jung postulates the child motif as the central symbol of the unfolding self towards wholeness. From the 'abandoned child' and the 'invincibility of the child', Jung derives the 'divine child' as hero. It is about the victory of consciousness over the unconscious, about the 'overcoming of the darkness monster'. But in this ego-psychological approach, there is no 'evil', no destructive child. The author is surprised that there is no concept of destructiveness per se, in the Kantian sense, in either psychoanalysis or analytical psychology. In Jung, 'evil' exists as a shadow dynamic that needs to be integrated. This paper is about destructiveness that cannot be integrated. The author's hypothesis is that some patients have the unconscious belief that they are a discarded child and were born as a 'bad' destructive child or have acquired this unconscious belief in the course of their development. Both possibilities are explored with regard to their treatability using clinical vignettes from the therapy of a child, an adolescent and an adult patient. With regard to collective destructiveness, an attempt is also made to highlight some characteristic beliefs of increasingly radicalized political and social groups. [ABSTRACT FROM AUTHOR]

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Background: Comorbid disorders often occur in psychoses from the schizophrenia spectrum and are an additional burden for patients' quality of life, render treatment and rehabilitation prognosis more difficult and can also contribute to suicidal ideation. Specifically, obsessive-compulsive syndrome (OCS) and OC disorder (OCD) have been reported. Objective: What is known about the epidemiology and pathogenesis and which conclusions can be drawn regarding the diagnostics and treatment? Material and methods: This review evaluated current reports on comorbid OCS during different stages of psychotic disorders, starting with the at-risk mental state (ARMS) via the first manifestation and up to chronic courses. The focus was on pharmacological and psychotherapeutic consequences. Results: Patients with ARMS suffer much more often from OCS than the general population. The prevalence is even higher in patients with a first manifestation of psychosis. During the chronic courses ca. 30% of patients are affected by comorbid OCS and 12% fulfill the diagnostic criteria of a OCD. The pathogenesis can most likely be explained by a genetic disposition in the glutamatergic system, shared structural and functional abnormalities of cortical and subcortical structures, pharmacological influences and psychosocial stressors. Conclusion: Clozapine and other antipsychotics may induce or aggravate OCS in a dose-dependent manner. In order to alleviate symptoms clozapine should be reduced to a minimally sufficient level. This can be attempted through combination, for example with dopaminergic antipsychotics. In general, serotonergic antidepressants can be added. Cognitive behavioral therapy should be offered to every patient with comorbid OCS. For future research multimodal longitudinal studies investigating the efficacy of interventions and aimed at the subjective level will be important. [ABSTRACT FROM AUTHOR]

With the help of vignettes from the treatment of patients suffering from psychotic disorders, the question of what role distance plays in the relationship between the analysand and the analyst is considered. It is the relation to the body, beginning with the fusional character of primary transference relationships, that acquires particular importance in this context, as it represents the starting point from which any primary distance in relationships can be perceived and established. The consequences this has for treatment technique are discussed. We examine the significance of and/or disturbances to the unconscious body image (Pankow, Sami-Ali) in particular, and demonstrate that by re-establishing a delimited image of the body primary distance can be created that makes the experience of separateness and difference possible. This provides the basis for a relationship to the living other as well as for learning from experience and is thus effective against psychosis. [ABSTRACT FROM AUTHOR]

In the psychoanalytic treatment of psychotics, it is difficult to find the right distance. Between fusion and rupture, ›the third‹ is often missing. In these severe cases, the introduction of a medium is often recommended. The psychoanalytic psychodrama, as it has been developed in psychoanalysis especially from the French-speaking world, offers theatre play as just such a medium. By incorporating acting into the analytic space, the therapist brings about a diffraction in the transferencial investment, thereby laying the groundwork for any genuine psychoanalytic treatment by making the interpretation of the transference possible. We would like to demonstrate this with some clinical examples. [ABSTRACT FROM AUTHOR]

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The purpose of this study was to investigate the relation between psychosis and body care. The experience report method was adopted, based on a work performed in a Psychosocial Care Center (CAPS). Delusional contents may hamper health promotion. There is an important rate of clinical comorbidities in people diagnosed with chronic mental disorders, due to factors such as smoking, poor diet, sedentary lifestyle, and medication side effects. Mental Health is a clinic of subjects, of singularities that need to exist and coexist in a collective, which requires creativity and sensitivity that does not fit into protocols. We need to build a possible care, consistent with the means that enable each subject to be in the world. [ABSTRACT FROM AUTHOR]

The authors, clinicians, and researchers in psychopath ology, developed a trans-structural psychic phenomenon found in obese patients who have undergone bariatric surgery: fantasies and delusions of body fragmentation. The psychic impact of bariatric surgery was studied based on a clinical case of neurosis and another one of psychosis, highlighting an alteration of body image and its sensations which would be at the origin of this phenomenon of fragmentation. [ABSTRACT FROM AUTHOR]

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Notre travail a pour but d'étudier le devenir des sujets considérés comme irresponsables sur le plan pénal en raison d'une abolition du discernement au titre de l'article 122-1 alinéa 1 du Code pénal et de mettre en évidence un lien entre leur pathologie, leur infraction et leur prise en charge. Cette étude observationnelle et rétrospective a recueilli auprès d'un expert psychiatre exerçant auprès de la cour d'appel de Rennes l'ensemble des expertises de 2015 à 2019 ayant conclu à l'abolition du discernement. Les Agences Régionales de Santé de la région ouest de la France ont été sollicitées afin d'obtenir les éléments concernant le devenir de ces sujets depuis leur examen expertal. Nous avons étudié les caractéristiques médico-psycho-criminologiques, les pathologies retrouvées, les infractions commises et les conclusions de l'expert concernant la responsabilisation ou l'irresponsabilisation pénale conduisant à la nécessité d'une orientation sanitaire ou judiciaire. Nous avons pu obtenir des informations concernant 58 sujets sur les 103 recueillis initialement. Au total, 19,42 % des sujets étaient en hospitalisation complète, 18,45 % en Programme de Soins et 17,48 % avaient bénéficié d'une levée de leur mesure. Les sujets souffraient d'un trouble psychotique dans 75,73 %. Pour une même infraction, cette population psychotique était plus souvent hospitalisée que les sujets non psychotiques (31,32 %) et parmi les sujets psychotiques, ils étaient également plus souvent hospitalisés en cas de crime (atteinte aux personnes ou crimes sexuels) commis que de délit (31,83 %). Notre hypothèse de départ a été confirmée par les tendances que nous avons pu dégager : les sujets considérés comme irresponsables sur le plan pénal ont tendance à rester hospitalisés, notamment lorsqu'ils sont psychotiques et qu'ils ont commis un crime. Article 122-1 of the French Penal Code regulates the status of non-criminally responsible (NCR) subjects due to an abolition of their judgment. Although little epidemiological data are available regarding the application of article 122-1, the French judicial literature reports a 0.2 to 0.5% rate of non-conviction due to psychiatric reasons. More recent studies report a higher rate, around 5%. The goal of our study was to determine the future of subjects considered to be NCR due to the abolition of their judgment, following article 122-1 §1 of the French Penal Code and to highlight a link between their pathology, their offenses and their management. This is a retrospective chart review, that included all the forensic assessments that took place between 2015 and 2019, of an expert psychiatrist, practicing at the Rennes Court of Appeal, and that resulted in a judgment of non-criminal responsibility. Information was retrieved from the Regional Health Agencies of the western region of France about the evolution of these subjects since their examination by the expert. Medico-psycho-criminological data was gathered, including the psychiatric profile, the committed offenses and the expert's conclusions regarding criminal accountability or non-criminal responsibility as well as the need for referral to the medical care or judicial system. 58 of the 103 initially identified charts were retained. Our sample consisted mainly of single men with no children, lacking professional qualifications but mostly employed. A majority of them had a positive psychiatric history, a history of substance use but no criminal history or childhood trauma. The ages ranged from 17 to 82 years, the mean age being 41 years (SD = 16 years). When the psychiatric expertise identified an abolition of judgment and non-criminally responsibility, 51.46% (95% CI: [41.40-61.43]) of the subjects were referred to in-patient psychiatric treatment. In 2020, 19,42% of subjects were hospitalized in a psychiatric unit, 18,45% were on compulsory outpatient treatment and 17,48% were no longer on compulsory treatment. Psychotic disorders were identified in 75,73% of the sample. For the same offense, this psychotic sub-population was more often hospitalized than the non-psychotic sub-population. Additionally, psychotic subjects were more often hospitalized in the event of a crime (injury to persons or sexual crimes) than of misdemeanor (31,83%). While we expected an overwhelming majority of hospital management following the recognition of the non-criminal responsibility, our study does not highlight a predominant outcome. Nonetheless, our initial hypothesis was confirmed by the trends we were able to identify: subjects considered to be non-criminally responsible tend to stay hospitalized, especially when they are psychotic and have committed a crime. [ABSTRACT FROM AUTHOR]

According to Jorge Garcia Badaracco, the gaze with which a patient is observed greatly influences the outcome of the treatment. To help the people to discover their "healthy virtuality", it is necessary that first the person in charge of the treatment observes it. Starting from this assumption, the authors reflect on what are the factors (intrinsic and extrinsic) that influence the gaze, and how important it is to modify first the way in which the caregivers observe patients and their families. Fear is a core element in contributing to the raise of defenses. It is the normality that can frighten a person suffering from psychosis, as well as his family and his caregivers, preventing him/her from seeing his/her "healthy virtuality". Have access to it implies tolerating deep pain; doing it within a multi-family psychoanalysis group help family members and practitioners to feel less frightened and less suffering. [ABSTRACT FROM AUTHOR]

Insofar as ‘sexuation’ is a process that begins before birth and is only completed, if ever, in adulthood, it is probably not abusive to speak of a ‘clinic of sexuation’ in children. Of course, without ignoring the conceptual difficulties that will arise, particularly with regard to the polymorphism of infantile sexuality and the so-called “latency phase”. The observation, proven for decades, that there are genuine situations of transsexualism in some children seems to be a good starting point for addressing these questions. [ABSTRACT FROM AUTHOR]

Psychosis produces a specific relationship to time which Lacan tries to theorize throughout his work. Its model is the hallucination, which he studies based on the paradigmatic example of the “sow”. This is indeed a return in the Real, but it also raises the question: What is the lacanian Real ? Its definition is in fact the very distortion of time due to problems of language. The free play of the signifier is impeded and there is no forgetting of the saying (‘le dire’), of enunciation. Hallucination persists in its presence, outside time, like the delusion that envelops it, and “protects” from the flow of words, that are subject to equivocation, often inauspiciously for the subject. [ABSTRACT FROM AUTHOR]

Harold Frederick Searles developed his contributions to psychoanalysis based on his clinical experience with psychosis, especially schizophrenia. He also elaborated important theories on the typical psychic illness of borderline cases. This article presents and discusses the role of intersubjectivity in Searles’ clinical thinking. To do so, the text analyzed the paper “The Schizophrenic’s Vulnerability to the Therapist’s Unconscious Processes” (1958/1965a). After presenting some biographical data about the author and his style as a writer and analyst, the article focuses on the analysis of the aforementioned paper. The discussion concludes by pointing out the relations between Searles’ clinical thinking and some contemporary analytical proposals. [ABSTRACT FROM AUTHOR]

This article discusses how the psychotic subject produces answers to the invasion of the real impossible to bear, contacting madness and inventive production. From the psychoanalytic theoretical field built by Freud and Lacan, we started the discussion about the mechanism of psychoses, the singularity, and specificity of psychotic speech, marking the delusion in its logic. And we move forward highlighting how the production of objects can be one of the stabilization paths in the clinic of psychoses. Through a bibliographic and documental review of a specific clinical case, we present the inventive approach of Arthur Bispo do Rosário, who, obeying the delusional injunction "It's time for you to rebuild the world", produced numerous objects, which made it possible to constitute a minimum condition of an agent facing the psychotic experience. [ABSTRACT FROM AUTHOR]