La thérapie comportementale dialectique : Recension des écrits scientifiques sur les groupes et applications dans une clinique de psychiatrie générale

Les personnes souffrant d’un trouble de la personnalité borderline (TPL) représentent une proportion importante de la clientèle hospitalisée en psychiatrie et de la clientèle ambulatoire. Elles consomment jusqu’à 40 % des ressources en santé mentale. La thérapie comportementale dialectique (TCD) est l’une des thérapies les mieux validées dans les écrits scientifiques pour traiter cette clientèle. Malheureusement, son déploiement au Québec demeure assez limité, entre autres à cause d’un manque de ressources pour offrir la thérapie individuelle et les appels téléphoniques d’urgence. Même si l’approche globale, telle que préconisée initialement, est peu accessible, plusieurs départements de psychiatrie proposent des groupes d’entraînement aux compétences aux personnes souffrant de TPL. Cet article vise à dresser un bref portrait de ce qu’est la TCD, de rendre compte des études sur les groupes TCD et de quelques adaptations existantes. L’auteure présentera le modèle appliqué dans deux milieux psychiatriques québécois, le Centre de santé et de services sociaux du Sud de Lanaudière et le pavillon Albert-Prévost, ainsi que les adaptations prévues dans le cadre du plan d’action en santé mentale.Patients suffering from borderline personality disorder (BPD) represent a substantial proportion of hospitalized and outpatient patients in psychiatry. They use up to 40% of mental health resources. Dialectical behavioral therapy (DBT) is one of the best studied treatment for this population. Unfortunately, its deployment in Quebec remains quite limited partly because resources are lacking to provide individual therapy and a response to emergency calls. Although the complete package, as originally studied, is not widely available, several psychiatric departments offer skills training groups for patients with BPD. This article aims to provide a brief overview of the DBT model, review studies on DBT groups and some existing adaptations to the original model. The author will also present the model used in two psychiatric settings, the Centre de Santé et Services Sociaux du Sud de Lanaudière and Pavilion Albert-Prévost, as well as the adaptations in the context of transfers to community health settings

La thérapie cognitivo-comportementale dans les cliniques spécialisées du Pavillon Albert-Prévost dans les 50 dernières années : innovations et évolution

Le Pavillon Albert-Prévost (PAP) a joué un rôle de premier plan dans le développement d’une psychiatrie moderne. Cette institution de soins et d’enseignement en santé mentale a été profondément marquée par la pensée freudienne et a longtemps été considérée comme un lieu phare de l’enseignement de la psychanalyse en milieu hospitalier au Québec. Mais le PAP a aussi su intégrer au fil des ans d’autres approches thérapeutiques, basées sur les données probantes. Si l’arrivée de cliniciens novateurs dans les années 1980, a permis la sensibilisation du milieu à d’autres approches thérapeutiques, la transformation du dispositif de soins en cliniques spécialisées, en 1994, marque un point décisif dans le développement de la thérapie cognitivo-comportementale, mais surtout dans son intégration dans le traitement quotidien de patients souffrant de problématiques diverses et dans son enseignement à des générations de cliniciens.The Pavillon Albert-Prévost (PAP) has played a leading role in the development of modern psychiatry in the province of Québec. It has also been, in the francophone milieu, the teaching hospital that was the most deeply influenced by psychoanalytic theories. The arrival of somatic approaches, particularly biofeedback and relaxation, in the Psychosomatic medicine and consultation-liaison service, as introduced by Dr. Jacques Monday in the 1970s, was initially greeted with great scepticism by the majority of his colleagues at PAP. In the 1980s and 1990s, Dr. Camille Laurin, then head of the department, invited Dr. Louis Chaloult to offer a clinical supervision seminar to mental health professionals. Drs. Chaloult and Monday trained generations of clinicians in cognitive behavior therapy and relaxation therapy as, over time, these approaches both practical, efficient and effective became more widely practiced and recommended by practice guidelines in psychiatry. Dr. Chaloult with the help of Dr. Jean Goulet developed a CBT teaching curriculum for residents in psychiatry and other health care professionals, wrote an influential textbook on CBT, co-developped a widely consulted website www.tccmontreal.com providing CBT practice guides for clinicians and patients alike, became one of the first psychiatrists acting as a psychiatre répondant in CLSCs (teaching CBT to other members of the team in order to provide CBT in primary care), co-developed the Centre de Psychothérapie at the PAP to promote cross theoretical training in psychotherapy for residents in psychiatry and interns of other mental healthcare disciplines. In this spirit, Dre. Thanh-Lan Ngô contributed to these endeavors and co-created with Dr. Jean Leblanc and Dre. Magalie Lussier-Valade another website www.psychopap.com dedicated to the transfer of knowledge in CBT as well as other forms of psychotherapy in order to celebrate 100 years of teaching in psychiatry at the PAP. Following the creation of specialised outpatient clinics in 1994, CBT was more widely offered and developed as a standard of care. These influential programs include those of three psychologists Dr Michel Dugas’ Generalised anxiety disorder model, Pascale Brillon’s teaching of trauma focussed CBT (with three books on the subject, Dr Richard Fleet’s research on emergency room presentation of panic disorder. This collaborative teaching and research program included Dre. Julie Turcotte and Dr. Pierre Savard, both specialised in CBT and instrumental in training generations of psychiatrists in evidence-based treatments for severe refractory disorders. At the Early psychosis clinic, an innovative program of CBT modules adapted to the functional and symptomatic impairment level of the heterogeneous clientele was developed by Pierre Fortier and Dr. Jean-Pierre Mottard. At the Readaptation for Psychosis program, France Bérubé and Jocelyne St-Onge, offered auditory hallucinations group, metacognitive therapy, the integrated psychotherapy programme. At the Personality disorder clinic, dialectical behavior therapy groups were offered by Julie Jomphe who trained many cohorts of residents, offered adaptations to families (Family connections), adolescents, and children (in schools). At the Psychosomatic service Donald Bouthillier treated somatisation disorders with affective-cognitive behavioral therapy for somatization disorder. And finally, at the Mood disorder clinic, Drs. Ngô, Bernard Gauthier, Léon Maurice Larouche, Anne-Sophie Boulanger along with Manon Quesnel, Renée Leblanc and colleagues offered a sequential program of CBT approaches to treat severe and refractory mood disorders

Mutations in SGOL1 cause a novel cohesinopathy affecting heart and gut rhythm

The pacemaking activity of specialized tissues in the heart and gut results in lifelong rhythmic contractions. Here we describe a new syndrome characterized by Chronic Atrial and Intestinal Dysrhythmia, termed CAID syndrome, in 16 French Canadians and 1 Swede. We show that a single shared homozygous founder mutation in SGOL1, a component of the cohesin complex, causes CAID syndrome. Cultured dermal fibroblasts from affected individuals showed accelerated cell cycle progression, a higher rate of senescence and enhanced activation of TGF-β signaling. Karyotypes showed the typical railroad appearance of a centromeric cohesion defect. Tissues derived from affected individuals displayed pathological changes in both the enteric nervous system and smooth muscle. Morpholino-induced knockdown of sgol1 in zebrafish recapitulated the abnormalities seen in humans with CAID syndrome. Our findings identify CAID syndrome as a novel generalized dysrhythmia, suggesting a new role for SGOL1 and the cohesin complex in mediating the integrity of human cardiac and gut rhythm