Schizophrénie, approche spécialisée et continuité de soins. Le programme spécifique d’intervention Premier-Épisode de l’Hôtel-Dieu de Lévis

La schizophrénie est une maladie complexe à caractère évolutif. Reposant sur un cadre conceptuel d'orientation cognitive, le programme spécifique d'intervention Premier épisode de l'Hôtel-Dieu de Lévis fournit une évaluation complète et standardisée au plan individuel et familial. Puis sont rendues disponibles différentes modalités de traitement, selon une approche individuelle (psycho-éducation, psychothérapie) et de groupe (intervention psychologique au plan cognitif ou Integrated Psychological Therapy, de Brenner). L'intervention psycho-éducative familiale est également offerte aux familles. Les structures et la démarche décrites s'harmonisent avec celles qui étaient en place avant la création du programme, ce qui offre une continuité de soins. Le cadre conceptuel sous-jacent et les modalités du fonctionnement du programme sont aussi présentés.Schizophrenia is a complex illness with an evolutive character. Based on a conceptual framework of cognitive orientation, the specific intervention program First Episode of Hôtel-Dieu in Lévis includes a complete and standardized assessment to an individualized and family plan. Different methods of treatment acording to an individualized approach (psyhco-education, psychotherapy) as well as group therapy (psychological intervention at the cognitive level or Brenner's Integrated psychological therapy) are then proposed. Psycho-education intervention for families is also offered. Structures and different steps described here, harmonize with those already in place before the program's creation thus offering a continuity in care. The underlying conceptual framework and the different methods of functioning of the program are also presented.La esquizofrenia es una enfermedad compleja da caracter evolu-tivo. El programa especifico de intervention Primer episodio de Hôtel-Dieu de Lévis que reposa en un marco conceptual de orientaciôn cognoscitiva, ofrece una evaluaciôn compléta y estandarizada a nivel individual y familiar. Ademâs se ofrecen diferentes modalidades de tratamiento, segûn un enfoque individual (psicoeducaciôn, psicoterapia) y de grupo (intervenciôn psicolôgica a nivel cognoscitivo o Integrated psychological therapy, de Brenner). Igualmente se le ofrece a las fami-lias, la Intervenciôn psioeducativa familiar. Las estructuras y los pasos a seguir que se describen se armonizan a las que ya existian antes de la creation del programa, Io que ofrece una continuidad de tratamiento. Son presentados, el marco conceptual subyacente y las modalidades del fucionamiento des programa

A collaborative model to implement flexible, accessible and efficient oncogenetic services for hereditary breast and ovarian cancer : the C-MOnGene study

Medical genetic services are facing an unprecedented demand for counseling and testing for hereditary breast and ovarian cancer (HBOC) in a context of limited resources. To help resolve this issue, a collaborative oncogenetic model was recently developed and implemented at the CHU de Québec-Université Laval; Quebec; Canada. Here, we present the protocol of the C-MOnGene (Collaborative Model in OncoGenetics) study, funded to examine the context in which the model was implemented and document the lessons that can be learned to optimize the delivery of oncogenetic services. Within three years of implementation, the model allowed researchers to double the annual number of patients seen in genetic counseling. The average number of days between genetic counseling and disclosure of test results significantly decreased. Group counseling sessions improved participants' understanding of breast cancer risk and increased knowledge of breast cancer and genetics and a large majority of them reported to be overwhelmingly satisfied with the process. These quality and performance indicators suggest this oncogenetic model offers a flexible, patient-centered and efficient genetic counseling and testing for HBOC. By identifying the critical facilitating factors and barriers, our study will provide an evidence base for organizations interested in transitioning to an oncogenetic model integrated into oncology care; including teams that are not specialized but are trained in genetics

Les variables cognitives associées au trouble obsessionnel-compulsif

Malgré le fait que les traitements basés sur l'exposition et la prévention de réponse ont clairement démontré leur efficacité avec le Trouble Obsessionnel- Compulsif (TOC), les résultats cliniques avec cette combinaison sont loin d'être optimaux. La thérapie cognitive pour le TOC est prometteuse. Les quatre études présentées ici ont pour but d'approfondir la compréhension des variables cognitives associées au TOC. La première étude appuie empiriquement le lien entre la surestimation du danger, la responsabilité et le perfectionnisme et les symptômes obsessionels-compulsifs (OC). La deuxième étude démontre que la correction des croyances idéographiques sans aucune forme d’exposition ou de prévention de réponse représente un traitement efficace avec les vérificateurs compulsifs. La troisième étude suggère qu'au moins un des mécanismes impliqués dans le traitement cognitif et le traitement comportemental impliquerait la précédence d'un changement cognitif sur la diminution de symptômes. Utilisant la même méthodologie, la quatrième étude démontre les liens bidirectionnels entre les états émotionnels indépendants, les cognitions et les symptômes. De plus, cette étude suggère que le processus de changement entre ces trois variables pourrait être différent chez les patients qui répondent bien ou non au traitement. Ces quatre études fournissent un appui empirique aux modèles théoriques formulés pour expliquer le TOC. Elles comportent également des implications cliniques considérables

L’interculturalité en intervention et le récit de soi : Quelle posture clinique? Quels enjeux méthodologiques?

Le contexte d’interculturalité est le lieu de rapports complexes. Dans le cadre de l’intervention, comment situer et appréhender la posture de la personne intervenante ? Notre article propose une réflexion sur des méthodes de récits basée sur un cadre conceptuel interculturel et de la sociologie clinique appliqués à l’intervention et à la recherche. Nous aborderons spécifiquement le récit de soi à travers le photolangage© et le récit d’expérience pour donner à voir que les postures professionnelles ne peuvent être comprises dans une linéarité mais plutôt dans la transversalité de positions idéal-typiques et de subjectivités.The intercultural context is the place of complex interactions. In the framework of the intervention, how could we comprehend the posture of the professional? Our article offers a reflection on narrative methods based on an intercultural conceptual framework and clinical sociology applied to intervention and research. Specifically, we will address the question of the narrative account of oneself towards the photolangage© and the narrative experience to show that the professional postures cannot be comprehended in the linearity but rather in the transversality of ideal-typical positions and subjectivities

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Functional and dysfunctional perfectionists : are they different on compulsive-like behaviors?

Both perfectionism and excessive responsibility have been linked to obsessive compulsive disorder (OCD). Up to now however, a greater number of studies have focused on the role of responsibility. The present study compared compulsive-like behavior of people with different styles of perfectionism. Sixteen functional perfectionists (FP) and 16 dysfunctional perfectionists (DP) were compared on three different tasks in order to explore OC type behavior such as doubting, checking and intrusions. Results show that DP participants, compared to FP participants, scored higher on an OC behavior scale, took significantly more time to complete a precision task and precipitated their decision when confronted with ambiguity. The two groups also tended to differ in their intrusive thoughts following an unsolved problem; FP participants were more preoccupied about solving the problem than about the quality of their performance, contrary to DP subjects. Results are discussed according to theoretical models of OCD

Relationship between Cardiometabolic Factors and the Response of Blood Pressure to a One-Year Primary Care Lifestyle Intervention in Metabolic Syndrome Patients

Systemic hypertension has been recognized as a modifiable traditional cardiovascular risk factor and influenced by many factors such as eating habits, physical activity, diabetes, and obesity. The objective of this cross-sectional study was to identify factors that predict changes in blood pressure induced by a one-year lifestyle intervention in primary care settings involving a collaboration between family physicians, dietitians, and exercise specialists. Patients with metabolic syndrome diagnosis were recruited by family physicians participating in primary care lifestyle intervention among several family care clinics across Canada. Participants for whom all cardiometabolic data at the beginning (T0) and the end (T12) of the one-year intervention were available were included in the present analysis (n = 101). Patients visited the dietitian and the exercise specialist weekly for the first three months and monthly for the last nine months. Diet quality, exercise capacity, anthropometric indicators, and cardiometabolic variables were evaluated at T0 and at T12. The intervention induced a statistically significant decrease in waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure, and plasma triglycerides, and an increase in cardiorespiratory fitness (estimated VO2max). Body weight (p p p = 0.006) reduction, and VO2max increase (p = 0.048) were all related to changes in SBP. WC was the only variable for which changes were significantly correlated with those in both SBP (p p = 0.0004). Variations in DBP were not associated with changes in other cardiometabolic variables to a statistically significant extent. Twelve participants were identified as adverse responders (AR) in both SBP and DBP and displayed less favorable changes in WC. The beneficial effects of the primary care lifestyle intervention on blood pressure were significantly associated with cardiometabolic variables, especially WC. These findings suggest that a structured lifestyle intervention in primary care can help improve cardiometabolic risk factors in patients with metabolic syndrome and that WC should be systematically measured to better stratify the patient’s hypertension risk