Universal cures for idiosyncratic illnesses: a genealogy of therapeutic reasoning in the mental health field

Over the past decades, there has been a significant increase in prescriptions of psychotropic drugs for mental disorders. So far, most of the explanations of the phenomenon have focused on the process of medicalization, but little attention has been cast towards physicians' day-to-day clinical reasoning, and the way it affects therapeutic decision-making. This article addresses the complex relationship between aetiology, diagnosis and drug treatment by examining the style of reasoning underlying prescribing practices through an historical lens. A genealogy of contemporary prescribing practices is proposed, that draws significant comparisons between 19th-century medicine and modern psychiatry. Tensions between specific, standardized cures and specific, idiosyncratic patients have been historically at play in clinical reasoning - and still are today. This inquiry into the epistemological foundations of contemporary drug prescription reveals an underlying search for scientific legitimacy

How Sensory Experiences Affect Adolescents with an Autistic Spectrum Condition within the Classroom

Sensory processing difficulties are consistently reported amongst individuals with an autistic spectrum condition (ASC); these have a significant impact on daily functioning. Evidence in this area comes from observer reports and first-hand accounts; both have limitations. The current study used the Adolescent/Adult Sensory Profile (AASP; Brown and Dunn in The Adolescent/Adult Sensory Profile: self questionnaire. Pearson, 2002a), and a qualitative questionnaire to investigate sensory issues in school children with ASC. The AASP found that the participants’ mean scores were outside normal parameters. Participants reported difficulties in at least one sensory domain, with hearing affecting them the most. Content analysis revealed sensory sensitivity to affect the participant’s learning and that sensory experiences were largely negative. Results suggest that schools need to create sensory profiles for each individual with ASC

Beyond the therapeutic: a Habermasian view of self-help groups’ place in the public sphere

Self-help groups in the United Kingdom continue to grow in number and address virtually every conceivable health condition, but they remain the subject of very little theoretical analysis. The literature to date has predominantly focused on their therapeutic effects on individual members. And yet they are widely presumed to fulfil a broader civic role and to encourage democratic citizenship. The article uses Habermas’ model of the public sphere as an analytical tool with which to reconsider the literature on self-help groups in order to increase our knowledge of their civic functions. In doing this it also aims to illustrate the continuing relevance of Habermas’ work to our understanding of issues in health and social care. We consider, within the context of current health policies and practices, the extent to which self-help groups with a range of different forms and functions operate according to the principles of communicative rationality that Habermas deemed key to democratic legitimacy. We conclude that self-help groups’ civic role is more complex than is usually presumed and that various factors including groups’ leadership, organisational structure and links with public agencies can affect their efficacy within the public sphere

TSP-1 Secreted by Bone Marrow Stromal Cells Contributes to Retinal Ganglion Cell Neurite Outgrowth and Survival

BACKGROUND: Bone marrow stromal cells (BMSCs) are pluripotent and thereby a potential candidate for cell replacement therapy for central nervous system degenerative disorders and traumatic injury. However, the mechanism of their differentiation and effect on neural tissues has not been fully elucidated. This study evaluates the effect of BMSCs on neural cell growth and survival in a retinal ganglion cell (RGCs) model by assessing the effect of changes in the expression of a BMSC-secreted protein, thrombospondin-1 (TSP-1), as a putative mechanistic agent acting on RGCs. METHODS AND FINDINGS: The effect of co-culturing BMSCs and RGCs in vitro was evaluated by measuring the following parameters: neurite outgrowth, RGC survival, BMSC neural-like differentiation, and the effect of TSP-1 on both cell lines under basal secretion conditions and when TSP-1 expression was inhibited. Our data show that BMSCs improved RGC survival and neurite outgrowth. Synaptophysin, MAP-2, and TGF-beta expression are up-regulated in RGCs co-cultured with BMSCs. Interestingly, the BMSCs progressively displayed neural-like morphology over the seven-day study period. Restriction display polymerase chain reaction (RD-PCR) was performed to screen for differentially expressed genes in BMSCs cultured alone or co-cultured with RGCs. TSP-1, a multifactorial extracellular matrix protein, is critically important in the formation of neural connections during development, so its function in our co-culture model was investigated by small interfering RNA (siRNA) transfection. When TSP-1 expression was decreased with siRNA silencing, BMSCs had no impact on RGC survival, but reduced neurite outgrowth and decreased expression of synaptophysin, MAP-2 and TGF-beta in RGCs. Furthermore, the number of BMSCs with neural-like characteristics was significantly decreased by more than two-fold using siRNA silencing. CONCLUSIONS: Our data suggest that the TSP-1 signaling pathway might have an important role in neural-like differentiation in BMSCs and neurite outgrowth in RGCs. This study provides new insights into the potential reparative mechanisms of neural cell repair

Packing : quand des parents témoignent

International audienceObjectif Dans un contexte très polémique qui a donné lieu à une interdiction du packing en 2016, l’objectif de cette étude est de donner la parole aux parents d’enfants autistes qui ne sont pas visibles médiatiquement et qui ont fait l’expérience du packing pour leur enfant. Méthode et résultats Par l’intermédiaire d’une pédopsychiatre, sept entretiens approfondis ont été réalisés en Seine-Saint-Denis, région où l’indice de désavantage social est très élevé et où la pénurie de places et de moyens est importante. Sept mères d’enfants autistes ont accepté de témoigner pour rendre compte de l’aide apportée par les professionnels et les effets bénéfiques du packing sur les manifestations les plus problématiques : automutilations, problèmes perceptifs, angoisses, agitation, cris. Conclusion Ces témoignages révèlent un net décalage entre la satisfaction des parents qui se sont exprimés et le mouvement anti-packing des associations de parents qui influencent les politiques publiques. Ils rendent compte d’une situation complexe qui nécessite la coopération de différents professionnels pour répondre au mieux aux questions que posent certains symptômes et manifestations de détresse extrême

Vécus de familles d’enfants autistes en période de confinement : étude exploratoire

International audienceObjective - The lockdown periods associated with the Covid-19 pandemic are a particularly significant challenge for families of children with autism. Exchanges by e-mail and interviews were aimed at collecting testimonies from parents for a better understanding of their difficulties and the help provided by the mobilization of professionals.Methods and results - Eight parents of autistic children living in the Seine-Saint-Denis area agreed to testify about their experience, either in person, taking into account the barrier measures after the first lockdown, or by telephone during the second lockdown. By way of comparison, e-mails were exchanged with a mother and two fathers of autistic children from higher socio-economic backgrounds living in other parts of France or Belgium. While at the beginning of the first lockdown, some children may have felt soothed by being at home with their parents, the extension of the situation led to crises related to feelings of anxiety or boredom. Despite the closure of many medical-social facilities, professionals mobilized to continue helping families and children whose routines were disrupted.Conclusion - Depending on the conditions of lockdown, the families’ experiences differed and evolved over time. The major problems encountered by some families were the worsening of their child's troubles (self-harm, tantrums, violence, and shouting). Pedagogical tools were adapted by the teachers, activity sheets were sent out, group workshops were organized, and consultations were given at a distance. The teams of the child psychiatry services and the medico-social services have mobilized themselves and have shown reactivity and inventiveness in order to ensure the care and follow-up of children and their families.Objectif - Les périodes de confinement liées à la pandémie de Covid-19 constituent un défi particulièrement important pour les familles d’enfants autistes. Des échanges par courriels et des entretiens ont eu pour objectif de recueillir des témoignages de parents afin de mieux appréhender leurs difficultés et l’aide apportée par les professionnels.Méthode et résultats - Huit parents d’enfants autistes vivant en Seine-Saint-Denis ont accepté de témoigner de leur expérience. À titre de comparaison, des courriels ont été échangés avec une mère et deux pères d’enfants autistes de milieu plus favorisé. Si au début du premier confinement, certains enfants ont pu se sentir apaisés, le prolongement de la situation a engendré des crises liées à des sentiments d’angoisse et d’ennui. Malgré la fermeture de nombreux établissements médico-sociaux, les professionnels se sont mobilisés pour continuer à aider les familles et les enfants dont les routines étaient perturbées.Conclusion - En fonction des conditions de confinement, le vécu des familles est différent et évolue avec le temps. Les problématiques majeures rencontrées par certaines familles ont été l’aggravation des troubles de leur enfant (automutilations, crises, violence, cris). Des outils pédagogiques ont été adaptés, des fiches d’activité ont été envoyées, des ateliers de groupe et des consultations ont été organisés à distance. Les services de pédopsychiatrie et les services médico-sociaux se sont mobilisés et ont fait preuve de réactivité et d’inventivité afin d’assurer un accompagnement des enfants et de leurs familles

L’autisme au quotidien : témoignage d’un pédiatre en Seine-Saint-Denis

International audienceA paediatrician who has been practicing for over 30 years in Seine-Saint Denis tells of the difficulties encountered by parents of autistic children living in this Paris suburb. He describes the serious shortfalls in the integration of these children in full-time schooling, the interweaving of social, cultural, educational and medical factors, the focus on diagnosis and research at the expense of follow-up and assistance to families, the shortage of professionals with an interest in these issues, and the “accounting” logic of hospital medicine. As he nears retirement, he worries about the drastic reduction in general practitioners and paediatricians in this suburban area, where the children from underprivileged families are dually penalised, on account of their illness and on account of their social situation.Un pédiatre qui exerce depuis plus de 30ans en Seine-Saint-Denis témoigne des difficultés particulières rencontrées par les parents d’enfants autistes qui vivent dans cette banlieue parisienne. Il raconte les profondes carences d’accueil en milieu éducatif à temps plein, l’intrication de facteurs sociaux, culturels, éducatifs et médicaux, la focalisation sur le diagnostic et la recherche au détriment du suivi et de l’aide aux familles, la mise à l’écart des enfants qui présentent le plus de difficultés, le manque de professionnels qui s’y intéressent et la logique comptable de la médecine à l’hôpital. À l’approche de la retraite, il s’inquiète de la diminution drastique des généralistes et pédiatres dans cette banlieue où les enfants de familles défavorisées sont doublement exclus, du fait de leur pathologie et de leur situation sociale