Psychopathologie collective et cryptoculture

Wahrend sich die Notwendigkeit aufdrängt, die kulturellen Gegebenheiten eines jeder psychiatrischen Praxis vorhergehenden Umfeldes zu berücksichtigen, gilt nicht unbedingt dasselbe fur all das, was sich, am Rande der etablierten Kultur und auf weniger ausdrückliche Weise, an Geruchten, Lebensweisheite, aber auch an Ungesagtem, formt, und dessen Verquickung einer Gemeinschaft eigen wird. Sobald jedoch dieses Verstândnis von Zugehörigkeit Wirklichkeit wird, kann diese anscheinend zweitrangige Alchimie so verreinnahmend werden, dass es vielleicht angemessener ware, von ihr als «Kryptokultur» zu sprechen, die es allerdings vor jeglicher therapeutischen Annährerung, sei sie globaler Art oder nicht, zu entschlüsseln gilt.Even though it is necessary to take into account the cultural datas of a society prior to any psychiatric practice, it isnt't the same for all the rumors, adages, and silences that are forming, on a less explicit mode in the margin of the main culture and whose amalgam becomes the characteristic of a community. However, when this notion of pertaining becomes effective, this alchimy apparently of minor importance can become so overwhelming that one should better refer to it as a «cryptoculture» that has to be imperatively decoded before undertaking any therapeutical approach, wheter systemical or not.Alors que la nécessité de prendre en compte les données culturelles d'un milieu précédemment à toute pratique psychiatrique s'impose, il n'en va pas de même pour tout ce qui, en marge de la culture établie, sur un mode moins explicite, se forme de rumeurs, d'adages, mais aussi de non-dit, et dont l'amalgame devient propre à une communauté. Pourtant, dès lors où cette notion d'appartenance devient effective, cette alchimie apparemment secondaire peut devenir si envahissante qu'il conviendrait peut-être mieux de parler à son sujet de «cryptoculture» qu'il s'agit alors de décoder impérativement avant d'entreprendre toute approche thérapeutique, systémique ou non.Zelfs wanneer het in acht nemen van de kulturele omgevingsfaktoren voorafgaand aan elke psychiatrische praktijk zich noodzakelijkerwijze opdringt, dan nog gelden andere regels voor allés wat zich op een minder uitgesproken wijze aan de rand van de gevestigde kultuur vormt en dit door een zonderling mengsel van geruchten, spreekwoorden en niet-gezegdes eigen aan een samenle- ving. Nochtans kan dergelijk samenraapsel na een algemene maatschappelijke aanvaarding zo overweldigend worden dat het wellicht beter past om te spreken van een «cryptokultuur», een geheime kultuur die zeker moet ontcijferd worden vooraleer men overgaat tot een al dan niet systematische therapeutische aanpak.Gaborit De Montjou Louis, Boisvert D., Guilé J. M., Zukowska K. Psychopathologie collective et cryptoculture. In: Déviance et société. 1989 - Vol. 13 - N°3. pp. 171-180

Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents: A chart review. European Child and Adolescent Psychiatry

j Abstract Background The existence of bipolar disorder type I (BD-I) during adolescence is now clearly established whereas there are still some controversies on BD-II and BD-NOS diagnosis, mainly in Europe (O'Dowd in Br Med J 29, 2006). Little is known on the phenomenology and potential short-term prognosis factors of bipolar episodes in this age population. In particular, very few studies examine this issue on inpatients in the European context of free access to care. Objective To describe the phenomenology of acute manic and mixed episodes in hospitalized adolescents and to analyse potential predictive factors associated with clinical improvement at discharge and length of hospitalization. Methods A total of 80 subjects, aged 12-20 years, consecutively hospitalized for a manic or mixed episode. Sociodemographic and clinical data were extracted by reviewing patients' charts. We used a multivariate analysis to evaluate shortterm outcome predictors. Results The sample was characterized by severe impairment, high rates of psychotic features (N = 50, 62.5%), a long duration of stay (mean 80.4 days), and an overall good improvement (86% very much or much improved). Thirtythree (41.3 %) patients had a history of depressive episodes, 13 (16.3%) had manic or brief psychotic episodes but only 3 (3.7%) had a history of attention deficit/ hyperactivity disorders. More manic episodes than mixed episodes were identified in subjects with mental retardation (MR) and in subjects from migrant and/or low socio-economic families. Overall severity and female gender predicted better improvement in GAF scores. Poor insight and the existence of psychotic features predicted longer duration of stay. Conclusion These results suggest that severe manic and mixed episodes in adolescents with BD-I need prolonged inpatient care to improve and that socio-cultural factors and MR should be examined more closely in youth with BD. j Key words bipolar disorder type I -acute episodeadolescent -prognosissocio-cultural factors BRIEF REPOR