La contrainte en psychiatrie: actualités et perspectives

La contrainte reste encore fréquemment utilisée en psychiatrie et tend à être considérée comme une nécessité, face à un patient en danger ayant perdu sa capacité de discernement. Cet article vise à rapporter et à discuter l'état actuel des connaissances scientifiques sur ce sujet. Les différentes mesures associées à la contrainte participent avec la maladie au stress vécu par les patients et pourraient compromettre leur adhésion aux offres de soins. La contrainte exercée, le statut légal et la contrainte ressentie sont trois dimensions à intégrer dans notre réflexion. Des pressions symboliquement négatives, positives ou légales sont exercées sur les patients et conduisent à s'interroger sur le développement d'alternatives à l'usage de la contrainte. L'introduction des directives anticipées dans des lois cantonales suisses pourrait ouvrir la voie à des modalités de collaboration différentes et mieux acceptées par les patients. [Auteurs]]]> Coercion ; Psychiatry ; Commitment of Mentally Ill ; Physician-Patient Relations oai:serval.unil.ch:BIB_B5BBAA6ED093 2022-05-07T01:25:32Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_B5BBAA6ED093 Significant reproductive skew in the facultatively polygynous ant Pheidole pallidula info:doi:10.1046/j.1365-294X.2003.02036.x info:eu-repo/semantics/altIdentifier/doi/10.1046/j.1365-294X.2003.02036.x info:eu-repo/semantics/altIdentifier/pmid/14653800 Fournier, D. Aron, S. Keller, L. info:eu-repo/semantics/article article 2004-01 Molecular Ecology, vol. 13, no. 1, pp. 203-10 info:eu-repo/semantics/altIdentifier/pissn/0962-1083 <![CDATA[Reproductive skew - the extent to which reproduction is unevenly shared between individuals in a social group - varies greatly between and within animal species. In this study, we investigated how queens share parentage in polygynous (multiple queen) colonies of the Mediterranean ant Pheidole pallidula. We used highly polymorphic microsatellites markers to determine parentage of gynes (new queens), males and workers in P. pallidula field colonies. The comparison of the genotypes of young and adult workers revealed a very low queen turnover (less than 2%). The first main finding of the study of reproductive skew in these colonies was that there was a significant departure from equal contribution of queens to gyne, male and worker production. Reproductive skew was greater for male production than for queen and worker production. There was no relationship between the magnitude of the reproductive skew and the number of reproductive queens per colony, their relatedness and the overall colony productivity, some of the factors predicted to influence the extent of reproductive skew. Finally, our study revealed for the first time a trade-off in the relative contribution of nestmate queens to gyne and worker production. The queens contributing more to gyne production contributed significantly less to worker production

HON Label and DISCERN as Content Quality Indicators of Health-Related Websites

Content quality indicators are warranted in order to help patients and consumers to judge the content quality of health-related on-line information. The aim of the present study is to evaluate web-based information on health topics and to assess particular content quality indicators like HON (Health on the Net) and DISCERN. The present study is based on the analysis of data issued from six previous studies which assessed with a standardized tool the general and content quality (evidence-based health information) of health-related websites. Keywords related to Social phobia, bipolar disorders, pathological gambling as well as cannabis, alcohol and cocaine addiction were entered into popular World Wide Web search engines. Websites were assessed with a standardized proforma designed to rate sites on the basis of accountability, presentation, interactivity, readability and content quality (evidence-based information). "Health on the Net” (HON) quality label, and DISCERN scale scores were used to verify their efficiency as quality indicators. Of 874 websites identified, 388 were included. Despite an observed association with higher content quality scores, the HON label fails to predict good content quality websites when used in a multiple regression. Sensibility and specificity of a DISCERN score >40 in the detection of good content quality websites were, respectively, 0.45 and 0.96. The DISCERN is a potential quality indicator with a relatively high specificity. Further developments in this domain are warranted in order to facilitate the identification of high-quality information on the web by patient

Quetiapine Dosage Across Diagnostic Categories

Objective The aim of the current study was to evaluate quetiapine doses used across diagnosis categories in a sample of psychiatric inpatients. Methods Discharge letters of all adult inpatients who had received quetiapine between 1999 and 2005 were retrospectively reviewed. Logistic regressions were carried-out to assess links between quetiapine discharge dosage (≥800mg/day vs. <800mg/day), diagnostic categories, substance abuse or dependence, benzodiazepine discharge doses, age and sex. Results The data of 231 patients were included. Five hundred and for discharge documents were analyzed: 113 for psychotic disorders, 190 for personality disorders, 134 for bipolar and schizoaffective bipolar disorders, 29 for unipolar depression or anxiety disorders, and 35 for mental retardation. Considering psychotic disorders as a reference group, patients with personality disorders were statistically significantly less likely to be in the high quetiapine dosage group at discharge (P=0.007, OR=0.1 and CI [0.03; 0.6]). Conclusions Quetiapine seems to be used in a variety of clinical situations, with a wide range of doses and a lower dosage in patients treated for personality disorder

Mirtazapine in drug-induced excessive sweating

Excessive sweating is a well-known side effect of a selective serotonin reuptake inhibitor treatment, but little is known about the impact of sweating on treatment discontinuation or the general quality of life of patients. In this case report, we present a patient suffering from excessive sweating induced by escitalopram. When mirtazapine was administered as an additional treatment, a dose-dependent reduction of drug-induced excessive sweating was observed. Taking into account the particular serotonin antagonistic properties of mirtazapine, its eventual influence on the regulation of body temperature and diaphoresis in the central nervous system is discusse

A follow-up study on the quality of alcohol dependence-related information on the web

In order to evaluate the one-year evolution of web-based information on alcohol dependence, we re-assessed alcohol-related sites in July 2007 with the same evaluating tool that had been used to assess these sites in June 2006. Websites were assessed with a standardized form designed to rate sites on the basis of accountability, presentation, interactivity, readability, and content quality. The DISCERN scale was also used, which aimed to assist persons without content expertise in assessing the quality of written health publications. Scores were highly stable for all components of the form one year later (r = .77 to .95, p < .01). Analysis of variance for repeated measures showed no time effect, no interaction between time and scale, no interaction between time and group (affiliation categories), and no interaction between time, group, and scale. The study highlights lack of change of alcohol-dependence-related web pages across one year

Impact of Psychiatrists' Qualifications on the Rate of Compulsory Admissions

Despite efforts to reduce coercion in psychiatry, involuntary hospitalizations remain frequent, representing more than half of all admissions in some European regions. Since October 2006, only certified psychiatrists are authorized to require a compulsory admission to our facility, while before all physicians were, including residents. The aim of the present study is to assess the impact of this change of procedure on the proportion compulsory admissions. All medical records of patients admitted respectively 4months before and 4month after the implementation of the procedure were retrospectively analyzed. This search retrieved a total of 2,227 hospitalizations for 1,584 patients. The overall proportions of compulsory and voluntary admissions were 63.9% and 36.1% respectively. The average length of stay was 32days (SD±64.4). During the study period, 25% of patients experienced two hospitalizations or more. The most frequent patients' diagnoses were affective disorders (30%), psychotic disorders (18.4%) and substance abuse disorders (15.7%). Compared with the period before October 2006, patients hospitalized from October 2006 up were less likely to be hospitalized on a compulsory basis (OR=0.745, 95% CI: 0.596-0.930). Factors associated with involuntary admission were young age (20years or less), female gender, a diagnosis of psychotic disorder and being hospitalized for the first time. Our results strongly suggest that limiting the right to require compulsory admissions to fully certified psychiatrists can reduce the rate of compulsory versus voluntary admission

Multidimensional Assessment of COVID-19-Related Fears (MAC-RF): A Theory-Based Instrument for the Assessment of Clinically Relevant Fears During Pandemics

In this article, we present the development and psychometric properties of the Multidimensional Assessment of COVID-19--Related Fears (MAC-RF). The MAC-RF is an eight-item, self-report scale that has been developed to assess clinically relevant domains of fear during the COVID-19 pandemic. The MAC-RF is based on a comprehensive theoretical model conceptualizing fears during the pandemics as resulting from an interaction of bodily, interpersonal, cognitive, and behavioral experiences. The MAC-RF was administered to a sample of 623 Italian adults from the community aged between 18 and 76 years old (M= 35.67, SD= 12.93), along with a measure of current clinical symptoms. Item response theory analyses demonstrated that each item of the MAC-RF provided sufficient information about the underlying construct of fear. The statistical fit of the scale was satisfactory. MAC-RF total scores correlated significantly and positively with total scores on the measure of psychopathology and with the clinical symptom domain scores. A ROC (receiver operating characteristic) curve analysis showed that the MAC-RF total score was sufficiently able to identify cases with high levels of current psychopathology, with an area under the curve of.76. These findings suggest that the MAC-RF can be used to assess pathological fear during pandemics. The English, Italian, and French versions of the MAC-RF are annexed to this article for use by clinicians and health services

Internet Poker Websites and Pathological Gambling Prevention Policy

Despite the widespread increase in online poker playing and the risk related to excessive poker playing, research on online poker websites is still lacking with regard to pathological gambling prevention strategies offered by the websites. The aim of the present study was to assess the pathological gambling-related prevention strategies of online poker websites. Two keywords ("poker” and "poker help”) were entered into two popular World Wide Web search engines. The first 20 links related to French and English online poker websites were assessed. Seventy-four websites were assessed with a standardized tool designed to rate sites on the basis of accountability, interactivity, prevention strategies, marketing, and messages related to poker strategies. Prevention strategies appeared to be lacking. Whereas a substantial proportion of the websites offered incitation to gambling such as betting "tips,” few sites offered strategies to prevent or address problem gambling. Furthermore, strategies related to poker, such as probability estimation, were mostly reported without acknowledging their limitations. Results of this study suggest that more adequate prevention strategies for risky gambling should be developed for online poke

Swiss Psychiatrists' Beliefs and Attitudes About Internet Addiction

Aims To investigate the beliefs and attitudes of Swiss general psychiatrists toward Internet addiction. Methods Ninety-fourth Swiss psychiatrists filled out a questionnaire at a conference of general psychiatry assessing their views on the concept of Internet addiction, their evaluation methods and treatment procedures they use. Results A cluster analysis revealed three groups: DISBELIEVERS (N=20) rejected the concept of Internet addiction and its importance, not considering it a real clinical problem and consequently not considering the existence of a specific treatment. The NOSOLOGY BELIEVERS (N=66) and NOSOLOGY/TREATMENT BELIEVERS (N=8) assumed that Internet addiction is a real problem. While NOSOLOGY/TREATMENT BELIEVERS asserted the availability of effective treatment (mainly psychological), NOSOLOGY BELIEVERS were less affirmative regarding treatment. Conclusion Thought the concept of Internet addiction is largely acknowledged as a clinical reality by Swiss psychiatrists, routine screening and treatment remain uncommon, mainly due to the belief that efficient treatment is still lackin