Réadaptation et psychose : de l’enveloppe soignante à l’enveloppe sociale

International audienceAfter a theoretical reminder of main notions of readjustment, rehabilitation, reintegration, the authors broaden the thought on readjustment from clinical experience near chronic psychotic patients in therapeutic flats.They show how the patient converts his ties with his circle and social world, through a new psychic organization with moments of crisis: the patient must gradually free oneself from “nursing envelope” to invest others envelopes, before being able to integrate a new group which constitute “social envelope”.Après un rappel théorique des notions essentielles de réadaptation, réhabilitation et réinsertion, les auteurs ouvrent la réflexion sur la réadaptation à partir d’une expérience clinique auprès de patients psychotiques chroniques en appartements thérapeutiques. Ils montrent comment le patient réaménage ses liens à son entourage et au monde social, à travers une réorganisation psychique parsemée de moments de crise: le patient doit progressivement se détacher de l’«enveloppe soignante» pour investir des enveloppes substitutives, avant de pouvoir intégrer un nouveau groupe constitutif de l’«enveloppe sociale»

Réadaptation et psychose : de l'enveloppe soignante à l'enveloppe sociale

International audienceAfter a theoretical reminder of main notions of readjustment, rehabilitation, reintegration, the authors broaden the thought on readjustmentfrom clinical experience near chronic psychotic patients in therapeutic flats.They show how the patient converts his tieswith his circle and social world, through a new psychic organization with moments of crisis: the patient must gradually free oneselffrom “nursing envelope” to invest others envelopes, before being able to integrate a new group which constitute “social envelope”.Après un rappel théorique des notions essentielles de réadaptation,réhabilitation et réinsertion,les auteurs ouvrent la réflexion sur la réadaptation à partir d’une expérience clinique auprès de patients psychotiques chroniques en appartements thérapeutiques. Ils montrent comment le patient réaménage ses liens à son entourage et au monde social,à travers une réorganisation psychique par-semée de moments de crise:le patient doit progressivement se détacher de l’«enveloppe soignante» pour investir des enveloppes substitutives,avant de pouvoir intégrer un nouveau groupe constitutif de l’«enveloppe sociale

Naissances de pensée

International audienceOffrant aux cliniciens et chercheurs français de nouveaux moyens de travail grâce à la traduction de l'Introduction aux idées psychanalytiques de Bion, Didier Anzieu (1976, XII) rappelait que, « s'il y a pour Bion un impensant, il n'y a pas d'impensable ». Et il regroupait,- sous la notion de « pensée primaire », tout à la fois la première « activité de penser », celle qui « à l'origine se confond avec un processus destiné à décharger le psychisme de l'excès de stimuli » et les pensées, qui ne sont alors « rien de plus que des impressions sensorielles et des vivances émotionnelles très primitives » (Grinberg et al., 1972, 51). Cette « pensée-acte », « je suis tenté, écrivait Anzieu, de l'appe- ler l'impensante : la pensée-mort psychique » (XI). Voilà pour « l'impensant » : celui qui ne peut être transformé chez le nourrisson que grâce à la « capacité de rêverie » de la mère (au sens de « capacité d'imagination non appuyée sur le raisonnement », Grinberg et al., 1972, 54), et celui qui est offert au travail psychanalytique, lorsque celui-ci se développe dans l'interaction avec des patients psycho- tiques ou souffrant de failles narcissiques : travail psychique « à la frontière de l'impensant et du premier pensant symbolisable » (XIII). La naissance de la pensée trouve alors son origine dans un travail effectué, selon Anzieu, « à la place du patient » (ou du bébé), puisque l'un et l'autre sont « hors d'état d'y pourvoir » (XIII). Remarque qui insiste sur la nécessité de l'engagement d'un appareil psychique extérieur à celui qui ne peut naître à la pensée sans l'aide d'un autre psychisme (Meltzer, 1984)

Plasticidad y evolutividad de los pacientes psicôticos en psicoterapia

International audienceThis writing maintains thé idea of change of psychic process with psychoticpatients. By proping up thé psychomerapy of a schizophrénie patient, thé authors show psychotic patient's évolution, byemphasizing thé modification of défensive mechanisms, of type of anguish, and thé transformation of status of deliriousideas. This évolution finds one of its expressions in thé relation with another ; so thé setting of therapeutic relation containsthé mark of it, as thé change of psychotic transfer and of clinician's psychic position bring out.Cet écrit soutient l'idée d'une plasticité du fonctionnement psychique des patients psychotiques. En s'étayant sur le suivid'un patient schizophrène, les auteurs montrent l'évolutivité du patient psychotique, en insistant sur la modification desmécanismes défensifs, du type d'angoisse et sur la transformation du statut des idées délirantes. Cette évolution trouve unede ses expressions dans la relation à un autre que soi ; le cadre de la relation psychothérapeutique en contient donc lamarque, comme le met en évidence le changement du transfert psychotique et du positionnement psychique du clinicien.El articule sostiene la idea de una plasticidad delfuncionamiento psfquico de los pacientes psicôticos. Basândose en el seguimiento de un paciente esquizofrénico, losautores muestran la evolutividad del paciente psicôtico, haciendo hincapié sobre la modificaciôn de los mécanismesdéfensives, del tipo de ansiedad y sobre la transformaciôn del estatuto de las ideas délirantes. Esta evoluciôn encuentra unade sus expresiones en la relaciôn a otro que a uno mismo; el marco de la relaciôn psicoterapéutica contiene la marca de ello,como lo demuestra el cambio de la transferencia psicôtica y el cambio del posicionamiento psfquico del terapeuta

Tribochimie du laminage à froid : étude par ToF-SIMS de la chimisorption sur la tôle des additifs du lubrifiant : Tribologie de la mise en forme des métaux

International audienceLa chimisorption des additifs de lubrifiant de laminage à froid sur un acier et un alliage d'aluminium est étudiée par spectrométrie de masse ToF-SIMS. L'étude préparatoire de l'adsorption des divers additifs permet de mettre en évidence leur rôle individuel, les compétitions d'adsorption, les seuils thermiques de désorption ou de décomposition. Ces résultats sont validés par des essais sur laminoir pilote = The chemisorption of cold rolling oil additives on steel and aluminium surfaces is studied with a mass spectrometry technique, ToF-SIMS. Preliminary experiments underline adsorption competition, and thermal threshold for desorption or decomposition. This results fit well with experimental cold rolling results

Good employees through good jobs : a latent profile analysis of job types and employee outcomes in the Belgian electricity sector

The question of what constitutes a good job concerns employers, employees and policymakers alike. Given the multiple possible contingencies, this study applies a latent profile analysis (LPA) to employee data from the Belgian electricity sector to identify different job types based on the combinations of various job demands and resources. These job types are subsequently related to employee outcomes in terms of work engagement and innovative work behaviour, for which threshold values are computed using relative operating characteristic (ROC) analysis. The combination of both methods reveals that low-strain jobs with high resources and reasonable demands perform the best in terms of work engagement. For innovative work behaviour, they perform equally well as active jobs which combine high demands with high resources. Employees in jobs with low resources and high demands (high-strain and very high-strain jobs) are less likely to be engaged and innovative.Purpose-The purpose of this paper is to identify different job types in the Belgian electricity sector and their relations with employee outcomes such as work engagement and innovative work behaviour (IWB). Design/methodology/approach-This paper uses a combination of latent profile analysis and relative operating characteristics (ROC) analysis. Findings-Depending on the job resources and demands, five different job types are identified corresponding largely to the Karasek and Theorell (1990) job types. Their relation with the outcomes is not parallel with low-strain jobs performing best for work engagement, and active jobs for IWB. Research limitations/implications-The combination of methods used in this study increases significantly the ease of communication of the findings, yet an external benchmark for the ROC analysis would be preferable. Practical implications-To foster engagement and IWB with employees one should focus on the job content and only increase demands if they are combined with sufficient resources. Originality/value-This research is the first in its kind that relates latent job types with different employee outcomes using a combination of latent profile and ROC analysis

The feasibility and efficacy of a multidisciplinary intervention with aftercare meetings for fibromyalgia

The objective of this study is to examine the feasibility and long-term results of a 12-week multidisciplinary part-time daycare intervention with five aftercare meetings in fibromyalgia (FM) patients. One hundred and five patients diagnosed with FM started with a multidisciplinary intervention and were assessed for feasibility, functional status (Fibromyalgia Impact Questionnaire [FIQ]), and quality of life (EuroQol-5D [EQ-5D]) until 9 months after completion. The program consisted of sociotherapy, physiotherapy, psychotherapy, and creative arts therapy. Drop-out rate was 4.8%. The attendance rate of 100 patients who completed the 12-week program and five aftercare meetings was high (97.4%), just like patient and therapist satisfaction (8.2 on a 10 points scale). After the 12-week program, statistically significant improvement was seen in both FIQ and EQ-5D. This improvement was maintained after 9 months of follow-up. On average, moderate improvements were observed. Our 12-week multidisciplinary part-time daycare intervention with five aftercare meetings for FM patients is feasible and it is indicated that it can lead to sustained improvement in functional status and quality of life

Redução de fatores de risco em jovens suicidas através de oportunidades de estabelecimento de laços sociais em serviços comunitários

Aim: This study examined the trajectory (life course) of youths, referred to community services following their suicidal behavior, in order to measure the extent to which these young people have taken this opportunity to modify connectedness with family, school, and workplace, and to change high-risk factors related to suicidal behaviors (mental health problems, delinquency, drug consumption). Method: Fifteen youths (aged 16-19), who made one or more suicide attempts or had serious ideation in the previous 24 to 48 months, were referred to community services (Vallée-Jeunesse). They were interviewed using an intensive personal interview measures (Trajectory Instrument Measure, TIM) in order to document significant life events and adversities that occured during different periods of their life.In addition, we administered the Structured Clinical Interview for DSM-IV Axis-I and Axis-II disorders (SCID-I and SCID-II) to identify past and current psychopathologies. Results: Several important changes took place following their entry into the community services: a reduction in delinquency and substance abuse/dependence, and positive changes in occupational status and suicidal behaviors (ideation and suicide attempt). Conclusion: Our findings can inform policies and strategies that support the prevention of suicidal behavior among young adults. Community services providers can play a role in the prevention of suicidal behaviors for the most vulnerable youths. These types of services could complement traditional suicide prevention strategies, which are mostly mental-health based.Objetivo: Este estudo analisou a trajetória (curso de vida) de jovens encaminhados para serviços comunitários após comportamento suicida, a fim de verificar em que medida aproveitaram essa oportunidade para modificar a ligação à família, escola e local de trabalho, e mudar fatores de alto risco relacionados com comportamentos suicidas (problemas de saúde mental, delinquência, consumo de drogas). Método: Quinze jovens (16-19 anos) que fizeram uma ou mais tentativas de suicídio ou manifestaram ideação suicida nos últimos 24 a 48 meses foram referenciados para serviços comunitários (Vallée-Jeunesse). Estes foram entrevistados através de entrevistas pessoais intensivas (Trajectory Instrument Measure, TIM), a fim de registar eventos significativos e adversidades que ocorreram durante diferentes períodos de sua vida. Adicionalmente, foi utilizada a Entrevista Clínica Estruturada para perturbações do Eixo-I e Eixo-II do DSM-IV (SCID-I e SCID-II) para identificar psicopatologias passadas e atuais. Resultados: Várias mudanças importantes ocorreram após a sua entrada nos serviços comunitários: uma redução na delinquência e abuso/dependência de substâncias, e mudanças positivas na situação ocupacional e comportamentos suicidas (ideação e tentativa de suicídio). Conclusão: Os resultados podem fundamentar políticas e estratégias que apoiem a prevenção do comportamento suicida em jovens adultos. Os prestadores de serviços comunitários podem desempenhar um papel na prevenção de comportamentos suicidas para os jovens mais vulneráveis. Esses tipos de serviços poderão complementar estratégias tradicionais de prevenção do suicídio, que são principalmente baseadas em abordagens da saúde mental

Gender differences in response to cold pressor test assessed with velocity-encoded cardiovascular magnetic resonance of the coronary sinus

BACKGROUND: Gender-specific differences in cardiovascular risk are well known, and current evidence supports an existing role of endothelium in these differences. The purpose of this study was to assess non invasively coronary endothelial function in male and female young volunteers by myocardial blood flow (MBF) measurement using coronary sinus (CS) flow quantification by velocity encoded cine cardiovascular magnetic resonance (CMR) at rest and during cold pressor test (CPT). METHODS: Twenty-four healthy volunteers (12 men, 12 women) underwent CMR in a 3 Tesla MR imager. Coronary sinus flow was measured at rest and during CPT using non breath-hold velocity encoded phase contrast cine-CMR. Myocardial function and morphology were acquired using a cine steady-state free precession sequence. RESULTS: At baseline, mean MBF was 0.63 ± 0.23 mL·g⁻¹·min⁻¹ in men and 0.79 ± 0.21 mL·g⁻¹·min⁻¹ in women. During CPT, the rate pressure product in men significantly increased by 49 ± 36% (p \textless 0.0001) and in women by 52 ± 22% (p \textless 0.0001). MBF increased significantly in both men and women by 0.22 ± 0.19 mL·g⁻¹·min⁻¹ (p = 0.0022) and by 0.73 ± 0.43 mL·g⁻¹·min⁻¹ (p = 0.0001), respectively. The increase in MBF was significantly higher in women than in men (p = 0.0012). CONCLUSION: CMR coronary sinus flow quantification for measuring myocardial blood flow revealed a higher response of MBF to CPT in women than in men. This finding may reflect gender differences in endothelial-dependent vasodilatation in these young subjects. This non invasive rest/stress protocol may become helpful to study endothelial function in normal physiology and in physiopathology