Below the symptom, within the setting, beyond the symptom…

peer reviewedThe symptom remains a kind of "royal road" into get to the day hospital. But what does it convey ? What innovative therapeutic responses can the day hospital provide ? After a brief reflexion on the symptom, from a semiologic and diagnostic point of view, and an overview of the psychodynamic, systemic and cognitive-behavioral models, we will examine the ingredients that nourish the integrative therapeutic work at the day hospital. Through clinical vignettes, we will describe the work of our institution by highlighting elements related to the concepts of institutional psychotherapy, setting, individual and group transferences and counter-transferences, holding, maternal and paternal functions, intrasubjective and intersubjective reality, object-shoring, and psychological envelope. We will present a particular therapeutic activity called "My Key" by looking at the work of symbolization carried out at the hospital, as well as the notions of the malleable medium and the transitional object. We will see how the day hospital, as an area of care within the scope of a temporal discontinuity, enables psychic continuity and opens the road to the subject’s recovery

Borderline Personality Disorder: Clinic Approach of a Psychopathology "Without Limits"

peer reviewedThe borderline personality disorder is a common psychiatric entity, which is characterized by a varied symptomatology and a significant comorbidity. It seems that its etiologic is heterogeneous, comprising psychosocial factors as much as biological and genetic. So the best approach of the borderline personality disorder would be a multidisciplinary bio-psycho-social one. Through a clinical case, we illustrate this disorder and its treatment in outpatient clinic

Evidence that the Two-Way Communication Checklist identifies patient-doctor needs discordance resulting in better 6-month outcome.

peer reviewedOBJECTIVE: To assess an intervention aimed at reducing patient-professional carer needs discordance. METHOD: In a group of 460 patients with schizophrenia, the Two-Way Communication Checklist (2-COM), an instrument to rate needs, was completed at baseline, 2 months and 6 months by both the patient and the professional carer, allowing for the quantification of patient-carer needs discordance. RESULTS: Reduction in patient-reported 2-COM needs in the group with low baseline needs discordance was much greater at 2 and 6 months (2 months: beta = -0.65, P < 0.001; 6 months: beta = -1.00, P < 0.001) than in the group with high baseline discordance (2 months: beta = -0.35, P < 0.001; 6 months: beta = -0.49, P < 0.001). Reduction in needs discordance between baseline and 2 months (beta = -0.07, P = 0.004) as well between 2 and 6 months (beta = -0.05, P = 0.020) was associated with greater levels of CGI clinical improvement. CONCLUSION: The fact that patient-carer needs discordance impacts negatively, and its reduction positively, on 6-month outcome suggests that systematic inventory of patient-carer views on needs is necessary

Chronos and the key of the time

peer reviewedL’argument de ce XLème Colloque des Hôpitaux de jour psychiatriques nous a plongés dans un abîme de questionnements théoriques et pratiques. Défiés par cette immersion dans les tréfonds du modèle, nous avons choisi de nous accrocher aux fondements de notre univers. La mythologie grecque sera donc notre source d’inspiration en mettant un dieu antique à notre disposition. Chronos sera notre guide dans un périple réflexif soumettant nos théories et notre pratique à l’épreuve du temps. Le récit de la conception d’un atelier thérapeutique, l’atelier « Art & Temps », sera notre fil d’Ariane dans notre tentative de symboliser notre pratique thérapeutique quotidienne et ses enjeux. Par la suite, l’exposé d’un cas clinique concrétisera un raisonnement théorique visant à situer notre modèle de prise en charge dans le réseau psychiatrique global

Belgique

Introduction : Initialement créée à partir du modèle du Big Five (Costa & McCrae, 1992), l'échelle Five-Factor Borderline Inventory, version courte (FFBI-SF ; DeShong et al., 2016) est un questionnaire de 48 items qui mesure 12 dimensions du trouble de la personnalité borderline. L'objectif de notre étude était d'adapter en français cette échelle psychométrique qui fournit une évaluation rapide (≈ 10 minutes), précise et différenciée de ce trouble. Méthode : nous avons recruté deux échantillons issus de la population générale : un échantillon d'étudiants universitaires (N=335) et un de travailleurs (N=162), soit un total de 497 participants. Tous les sujets devaient compléter cinq questionnaires, un questionnaire démographique, ensuite (aléatoirement) le FFBI-SF, le Big Five Inventory (BFI ; John et al., 1991), le McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD ; Zanarini et al., 2003) et la version courte de la Borderline Symptom List (BSL-23 ; Bohus et al., 2001). Après une traduction suivie d’une backtranslation, nous avons réalisé des analyses exploratoire et confirmatoire afin de tester la structure en 12 facteurs du modèle. Nous avons également testé les indices de fidélité de l'échelle ainsi que la validité incrémentale et convergente. Résultats : nos résultats ont permis de démontrer que la consistance interne du questionnaire était excellente (α = .95) et, pour les dimensions, les indices étaient de satisfaisants à bons. Au niveau de la validité convergente, on constate que le FFBI-SF partage des corrélations fortes (r > .69) avec ces homologues (MSI-BPD et BSL-23), ce qui montre que ces échelles mesurent un construct similaire. Toutefois, les analyses de validité incrémentale nous montrent que le FFBI-SF offre une réelle plus-value par rapport aux deux autres échelles, étant donné qu'il apporte une part de variance supplémentaire allant de 13 à 23%. On retrouve également un pattern de corrélations similaire à celui trouvé par DeShong et al. (2016) entre FFBI-SF et BFI, ce qui montre, comme ces auteurs l'ont proposé, que les dimensions du FFBI-SF sont bel et bien une version "pathologique" de traits "normaux" de personnalité. Enfin, les indices d'adéquation du modèle étaient acceptables pour les deux échantillons (EFA : KMO = .91/.87 ; RMSEA = .0447/.0573 ; TLI = .92/.91 ; R² = .60/.64 ; CFA : SRMR = .0636/.0785 ; RMSEA = .0675/.0811 ; CFI = .823/.765 ; TLI = .803/.739). Conclusion : ces résultats montrent que l'adaptation française du FFBI-SF est fidèle et valide. De plus, l'échelle offre une appréhension multi-dimensionnelle du trouble de la personnalité borderline, contrairement aux autres échelles qui proposent une structure à un seul facteur. Dès lors, le FFBI-SF répond à un besoin croissant des chercheurs et des cliniciens de bénéficier d'outils multi-facettes présentant de bonnes qualités psychométriques, qui soient accessibles et rapidement complétés pour évaluer les troubles de la personnalité borderline

Les étudiants en médecine sont-ils plus empathiques pendant la pandémie ?

Si la détresse psychologique liée au Covid-19 est déjà bien documentée au sein de la population générale, la crise sanitaire a-t-elle eu un impact sur le processus empathique auprès des étudiants en médecine? En 2021, un an après le début de la la crise sanitaire, nous avons étudié une nouvelle cohorte d’étudiants (Cohorte C) et l’avons comparée à deux précédentes cohortes analysées en 2016-2017 (Cohorte A) et 2018-2019 (Cohorte B). En raison du contexte pandémique, nous nous attendions à une augmentation des scores d’empathie affective et à une diminution des scores d’empathie cognitive. Nous avons partiellement confirmé cette hypothèse. Effectivement, nous avons observé dans la Cohorte C des scores significativement plus élevés d’empathie affective mais, de manière surprenante, nous avons également constaté des scores d’empathie cognitive plus élevés par rapport aux Cohortes A et B. Contrairement aux apparences, ces résultats nous paraissent préoccupants et semblent témoigner d’ une altération de la santé mentale des étudiants en médecine

Individual differences and personality traits across situations

peer reviewedBackground According to the Big Five theory, personality can be classified into five traits (i.e., extraversion, neuroticism, conscientiousness, agreeableness, and openness), and past research showed that situations impact personality. In the present study, (1) we measured which of these five personality traits changed according to different situations and (2) tested whether the across-situation variability (ASV; i.e., a continuous variable showing how much people change their personality traits according to situations) was significantly connected with specific personality domains, revealing a potential marker of personality disturbance. Participants and procedure We recruited 80 participants (40 women) to complete the five situation-version (family, work, friends, romantic partner, and hobbies/leisure) of the Big Five Inventory to measure whether personality traits significantly changed across these situations. In addition, we ran a network analysis to reveal how the ASV is related to personality traits. Results The findings showed that all traits significantly changed across the situations, except openness, which remained stable. The network analysis revealed that the ASV variable was especially connected with conscientiousness (in romantic partner and family situations). Conclusions Most personality traits were flexible, showing how important it is to consider the role of situations in the study of personality. Openness appeared to be particularly stable and understanding its nature represents a challenge for future studies. Finally, the network analysis demonstrated that the ASV shows specific connections with conscientiousness and might be a potential psychopathology marker

Medical students’ empathy during the COVID-19 pandemic : a cross-sectional study

Several authors have underlined the negative consequences of the COVID-19 pandemic on mental health in several populations, including medical students, such as increases in anxiety, depression and burnout symptoms. Furthermore, previous studies showed that anxiety and depressive symptoms are positively associated with affective empathy and negatively associated with cognitive empathy. Given the adverse pandemic effects highlighted by several authors, the present study sought to determine whether medical students’ empathy has been potentially impacted, with higher affective empathy and lower cognitive empathy score in the pandemic cohort compared to pre-pandemic cohorts. Medical students (n = 395) were recruited during the COVID-19 pandemic and completed the Interpersonal Reactivity Index (IRI) and the Basic Empathy Scale (BES). This cohort was then compared with two pre-pandemic cohorts (one used the BES [n = 1168], and the other used the IRI [n = 342]). Similar results were found on both scales: the pandemic cohort displayed significantly higher scores in affective empathy and personal distress (affective empathy domain) and, surprisingly, significant higher scores in cognitive empathy, fantasy, and perspective-taking (cognitive empathy domains). As stressed by previous studies, we posited that the higher scores in affective empathy, personal distress, and fantasy might indicate emotional difficulties. The paper concludes with the identification of empathy components that should be promoted in the curriculum of medical students.peer-reviewe

Estime de soi et dynamique d'apprentissage chez les étudiants infirmiers : une étude phénoménologique existentielle

peer reviewedAim: To describe nursing student self-esteem changes over time and its impacts on learning strategies. Design: Existential phenomenology. Methods: Interviews were conducted in Spring 2018 in a purposive sample of 39 nursing students, exploring events critical to self-esteem and their impacts. Transcriptions were analysed descriptively and interpretatively to decipher the process that links self-esteem, events and learning behaviour. Results: What led to self-esteem changes were “relationships with nurses during internships” and “receiving evaluations.” The students interpreted events and drew conclusions about their aptitude for nursing, which in turn prompted proactive or defensive learning behaviours. Their interpretations both depended on their self-esteem and impacted it, in a vicious or virtuous circle. Exploring self-esteem allows a better understanding of the importance of students' relationships with nursing teams, and of some of their defensive behaviours. Understanding the role of nursing student self-esteem in the learning process could help improve student well-being and competence