Traitement multimodal de l’agressivité et de la violence chez des personnes souffrant de psychose

Dans cet article, les auteurs décrivent les traitements non pharmacologiques qui ont fait preuve d’efficacité pour réduire l’agressivité et la violence chez les personnes souffrant de psychose. Ils présentent ensuite une approche de formulation/planification du traitement qui aborde les influences étiologiques complexes, et les facteurs multiples qui jouent sur le maintien du comportement agressif chez ces patients. Finalement, ils présentent en exemple un cas où l’on se sert de cette approche.In this article, the authors offer a description of nonpharmacological treatments which have demonstrated effectiveness in reducing aggression and violence in patient with psychosis ; present a case formulation/treatment planning approach which addresses the complex etiological influences and multiple factors affecting maintenance of aggressive behavior in PI ; finally, they provide a case example of this approach.En este artículo, los autores describen los tratamientos no farmacológicos que han demostrado ser eficaces en la reducción de la agresividad y la violencia en las personas que sufren de psicosis. Enseguida, presentan un enfoque de formulación/planificación del tratamiento que aborda las influencias etiológicas complejas y los múltiples factores que tienen un efecto en el mantenimiento del comportamiento agresivo en estos pacientes. Finalmente, presentan como ejemplo un caso en el que se sirven de este enfoque.Neste artigo, os autores descrevem os tratamentos não farmacológicos que provaram ser eficazes para reduzir a agressividade e a violência nas pessoas que sofrem de psicose. Eles apresentam em seguida uma abordagem de formulação/planificação do tratamento que aborda as influências etimológicas complexas, e os fatores múltiplos que influenciam sobre a manutenção do comportamento agressivo nestes pacientes. Finalmente, eles apresentam o exemplo de um caso onde esta abordagem foi utilizada

Techniques interpersonnelles pour optimiser les résultats positifs de la réhabilitation psychiatrique (deuxième partie)

Il existe maintenant un certain nombre de traitements comportementaux basés sur le milieu ou le groupe qui ont démontré leur efficacité auprès des patients souffrant de schizophrénie dits « réfractaires aux traitements » Toutefois, il est peu probable que ces interventions atteignent leur impact maximal, à moins que le personnel soignant ne s’inspire systématiquement des principes comportementaux dans leurs interactions constantes avec les patients tout au cours de la journée. Dans cet article, les auteurs décrivent certaines techniques interpersonnelles qui sont efficaces pour la gestion d’une gamme variée de comportements institutionnalisés/dépendants et provocateurs/agressifs. Chaque technique est expliquée et des exemples détaillés sont présentés, afin d’illustrer des réponses appropriées et inappropriées de la part du personnel soignant à l’égard des comportements des patients. La discussion conclut avec une description d’un contrat de comportement réussi qui s’inspire de certaines de ces techniques.There now exist a number of milieu-based and group-based behavioral treatments that have demonstrated effectiveness with so-called “treatment-refractory” schizophrenia patients. These interventions are not likely to achieve their maximal impact, however, unless program staff consistently employ behavioral principles in their moment-to-moment interactions with patients throughout the day. In this paper we describe a number of interpersonal techniques that are effective in dealing with a variety of institutionalized/dependent and provocative/aggressive behaviors. Each technique is explained and detailed examples are given to demonstrate appropriate and inappropriate staff responses to patient behavior. The discussion ends with the description of a successful behavior contract that employed a number of these techniques.Actualmente existe un cierto número de tratamientos comportamentales, basados en el medio o el grupo, que han demostrado su eficacia en los pacientes esquizofrénicos llamados “refractarios a los tratamientos”. Sin embargo, es poco probable que estas intervenciones alcancen su impacto máximo, a menos de que el personal de asistencia médica se inspire sistemáticamente de los principios comportamentales en sus interacciones constantes con los pacientes a lo largo de todo el día. En este artículo, los autores describen ciertas técnicas interpersonales que son eficaces para la gestión de una gama variada de comportamientos institucionalizados/dependientes y provocadores/ agresivos. Se explica cada técnica y se presentan ejemplos detallados a fin de ilustrar las respuestas apropiadas e inapropiadas del personal de asistencia médica con respecto a los comportamientos de los pacientes. La discusión concluye con la descripción de un acuerdo de comportamiento exitoso que se inspira de algunas de estas técnicas.Existem atualmente alguns tratamentos comportamentais baseados no meio ou no grupo, que demonstraram sua eficácia junto a pacientes que sofrem de esquizofrenia ditos “refratários aos tratamentos”. Entretanto, é pouco provável que estas intervenções atinjam seu impacto máximo, a menos que os funcionários que tratam destes pacientes inspirem-se sistematicamente dos princípios comportamentais em suas interações constantes com os pacientes durante o dia. Neste artigo, os autores descrevem algumas técnicas impessoais que são eficazes para a gestão de uma vasta gama de comportamentos institucionalizados/dependentes e provocadores/agressivos. Cada técnica é explicada e exemplos detalhados estão presentes para ilustrar respostas apropriadas e não apropriadas da parte dos funcionários que tratam destes pacientes no que diz respeito aos comportamentos destes. A discussão conclui com a descrição de um contrato de comportamento que deu certo que inspira-se de algumas destas técnicas

Gestion clinique et réhabilitation du patient souffrant de schizophrénie et réfractaire au traitement : fondements conceptuels et résultats (première partie)

Malgré les percées importantes en psychopharmacologie dans le traitement des personnes souffrant de schizophrénie, plusieurs patients demeurent trop handicapés pour obtenir leur congé des établissements psychiatriques publics. Cet article décrit le développement d’un partenariat entre les secteurs public et privé qui a mené à la création d’un programme spécialisé et intensif de réhabilitation behaviorale, dans les hôpitaux publics, à l’intention des patients souffrant de schizophrénie, et considérés réfractaires aux traitements. Les éléments essentiels de ce programme et ses fondements philosophiques y sont décrits. Des données sur les résultats sont discutées afin de souligner le fait que lorsque des traitements basés sur des données probantes sont dispensés à cette population, les résultats peuvent être positifs dans la plupart des cas. Et le nombre de patients « réfractaires aux traitements » devient moindre lorsque son estimation n’est pas seulement basée sur la réponse aux médicaments.Despite advances in psychopharmacology for people with schizophrenia, many patients remain too disabled to be discharged from public psychiatric facilities. This paper decribes the development of a public-private partnership which led to the creation of a specialized, intensive behavioral rehabilitation program for schizophrenia patients who were considered to be treatment-refractory at public hospitals. The essential elements of this treatment program are described, along with the philosophical bases of its treatment. Outcome data are discussed to emphasize the point that when evidence-based treatment is implemented with this population, outcomes can be positive in most cases, and therefore, the number of « treatment-refractory » patients is actually less than is estimated based on response to medication alone.A pesar de los avances importantes de la psicofarmacología en el tratamiento de las personas con esquizofrenia, muchos pacientes siguen estando demasiado discapacitados para obtener sus incapacidades en los establecimientos psiquiátricos públicos. Este artículo describe el desarrollo de una asociación entre el sector público y privado, que ha conducido a la creación de un programa especializado e intensivo de rehabilitación conductista, en los hospitales públicos, para los pacientes que sufren de esquizofrenia y que son considerados como refractarios a los tratamientos. Los elementos esenciales de este programa y sus fundamentos filosóficos son descritos en este artículo. También se discuten los datos de los resultados con el fin de subrayar el hecho de que cuando los tratamientos basados en los datos probantes son presentados a esta población, los resultados pueden ser positivos en la mayoría de los casos y el número de pacientes “refractarios a los tratamientos” disminuye cuando su estimación no se basa sólo en su respuesta a los medicamentos.Apesar das descobertas importantes em psicofarmacologia no tratamento de pessoas que sofrem de esquizofrenia, vários pacientes continuam debilitados demais para obter sua alta dos estabelecimentos psiquiátricos públicos. Este artigo descreve o desenvolvimento de uma parceria entre os setores público e privado que levou à criação de um programa especializado e intensivo de reabilitação behaviorista, nos hospitais públicos, para pacientes que sofrem de esquizofrenia, considerados refratários aos tratamentos. Os elementos essenciais deste programa e seus fundamentos filosóficos são descritos no artigo. São discutidos dados sobre os resultados para ressaltar o fato de que, quando tratamentos baseados nos dados probatórios são dispensados a esta população, os resultados podem ser positivos na maior parte dos casos. O número de pacientes “refratários aos tratamentos” diminui quando sua estimativa não é somente baseada na resposta aos medicamentos

Techniques pour améliorer l’attention et l’engagement dans le traitement des patients souffrant de schizophrénie avec de graves déficits cognitifs (troisième partie)

Malgré l’existence de plusieurs interventions psychiatriques de groupe efficaces, beaucoup de patients gravement atteints sont incapables d’en bénéficier en raison de leur incapacité à maintenir leur attention lors des sessions de groupe. L’inattention pourrait être due à un ou plusieurs facteurs, dont un déficit d’attention, une faible motivation, aux effets sédatifs de la médication, et aux hallucinations et pensées troublantes dont l’effet interfère. Les interventions typiques de réhabilitation cognitive existantes pour la schizophrénie n’abordent pas ces facteurs, mais ciblent les fonctions de haut niveau comme la mémoire, l’apprentissage, la résolution de problèmes et le fonctionnement exécutif. Dans cet article, les auteurs décrivent des techniques qui insistent sur l’attention et l’engagement des patients gravement atteints et réfractaires aux traitements. Ces techniques concernent à la fois les interventions individuelles et les interventions de groupe.While many effective group-based psychiatric rehabilitation interventions now exist, many severely disabled patients are unable to benefit from them due to a reduced ability to pay attention in group sessions. Moreover, inattentiveness can be due to one or more of multiple factors, including a sustained attention deficit, poor motivation, sedating side effects of medication, and the interfering effects of hallucinations and disturbing thoughts. Existing cognitive rehabilitation interventions for schizophrenia typically do not address these factors, instead targeting higher level functions such as memory, learning, problem-solving, and executive functioning. In this paper, we describe techniques for promoting attentiveness and treatment engagement among severely disabled “treatment-refractory” patients. This includes both individual and group-based interventions.A pesar de la existencia de varias intervenciones psiquiátricas de grupos eficaces, muchos pacientes gravemente afectados son incapaces de beneficiarse con ellas debido a su incapacidad de mantener la atención durante las sesiones de grupo. La falta de atención podría deberse a uno o varios factores, entre ellos a un déficit de atención, una motivación débil, los efectos sedativos de la medicación y las alucinaciones y pensamientos perturbadores cuyo efecto interfiere. Las intervenciones típicas de rehabilitación cognitiva existentes para la esquizofrenia no abordan estos factores, pero se enfocan en las funciones de nivel elevado como la memoria, el aprendizaje, la resolución de problemas y el funcionamiento ejecutivo. En este artículo, los autores describen las técnicas que insisten en la atención y la implicación de los pacientes gravemente afectados y refractarios a los tratamientos. Estas técnicas conciernen a la vez a las intervenciones individuales y a las intervenciones de grupo.Apesar da existência de várias intervenções psiquiátricas de grupo eficazes, muitos pacientes gravemente atingidos são incapazes de usufruir destas intervenções por causa de sua incapacidade em manter a atenção durante sessões de grupo. A falta de atenção poderia ser devida a um ou vários fatores, entre eles a um déficit de atenção, a uma baixa motivação, aos efeitos sedativos da medicação e às alucinações e pensamentos perturbadores cujo efeito pode interferir no tratamento. As intervenções típicas de reabilitação cognitiva existentes para a esquizofrenia não abordam estes fatores, mas visam as funções de alto nível como a memória, a aprendizagem, a resolução de problemas e o funcionamento executivo. Neste artigo, os autores descrevem técnicas que insistem na atenção e no empenho dos pacientes gravemente atingidos e refratários aos tratamentos. Estas técnicas tratam ao mesmo tempo das intervenções individuais e das intervenções de grupo

The Effects of Attentional Engagement on Route Learning Performance in a Virtual Environment: An Aging Study

Route learning is a common navigation task affected by cognitive aging. Here we present a novel experimental paradigm to investigate whether age-related declines in executive control of attention contributes to route learning deficits. A young and an older participant group was repeatedly presented with a route through a virtual maze comprised of 12 decision points (DP) and non-decision points (non-DP). To investigate attentional engagement with the route learning task, participants had to respond to auditory probes at both DP and non-DP. Route knowledge was assessed by showing participants screenshots or landmarks from DPs and non-DPs and asking them to indicate the movement direction required to continue the route. Results demonstrate better performance for DPs than for non-DPs and slower responses to auditory probes at DPs compared to non-DPs. As expected we found slower route learning and slower responses to the auditory probes in the older participant group. Interestingly, differences in response times to the auditory probes between DPs and non-DPs can predict the success of route learning in both age groups and may explain slower knowledge acquisition in the older participant group

How do we get there? Effects of cognitive aging on route memory

© 2017 The Author(s) Research into the effects of cognitive aging on route navigation usually focuses on differences in learning performance. In contrast, we investigated age-related differences in route knowledge after successful route learning. One young and two groups of older adults categorized using different cut-off scores on the Montreal Cognitive Assessment (MoCA), were trained until they could correctly recall short routes. During the test phase, they were asked to recall the sequence in which landmarks were encountered (Landmark Sequence Task), the sequence of turns (Direction Sequence Task), the direction of turn at each landmark (Landmark Direction Task), and to identify the learned routes from a map perspective (Perspective Taking Task). Comparing the young participant group with the older group that scored high on the MoCA, we found effects of typical aging in learning performance and in the Direction Sequence Task. Comparing the two older groups, we found effects of early signs of atypical aging in the Landmark Direction and the Perspective Taking Tasks. We found no differences between groups in the Landmark Sequence Task. Given that participants were able to recall routes after training, these results suggest that typical and early signs of atypical aging result in differential memory deficits for aspects of route knowledge

Dietary polyphenol supplementation prevents alterations of spatial navigation in middle-aged mice

Spatial learning and memory deficits associated with hippocampal synaptic plasticity impairments are commonly observed during aging. Besides, the beneficial role of dietary polyphenols has been suggested as potential functional food candidates to prevent this memory decline. Indeed, polyphenols could potentiate the signaling pathways of synaptic plasticity underlying learning and memory. In this study, spatial learning deficits of middle-aged mice were first highlighted and characterized according to their navigation patterns in the Morris water maze task. An eight-week polyphenol-enriched diet, containing a polyphenol-rich extract from grape and blueberry (PEGB; from the Neurophenols Consortium) with high contents of flavonoids, stilbenes and phenolic acids, was then successful in reversing these age-induced effects. The use of spatial strategies was indeed delayed with aging whereas a polyphenol supplementation could promote the occurrence of spatial strategies. These behavioral results were associated with neurobiological changes: while the expression of hippocampal calmodulin kinase II (CaMKII) mRNA levels was reduced in middle-aged animals, the polyphenol-enriched diet could rescue them. Besides, an increased expression of nerve growth neurotrophic factor (NGF) mRNA levels was also observed in supplemented adult and middle-aged mice. Thus these data suggest that supplementation with polyphenols could be an efficient nutritional way to prevent age-induced cognitive decline