Sante Mentale au Quebec最新文献

Objectives The objective of this study is to develop the logic model and the content of the Borderline Intervention for Work Integration (BIWI). Methods The creation of BIWI was based on Chen's (2015) recommendations for establishing the change model and the action model. Individual interviews with four women with a borderline personality disorder (BPD) and focused groups with occupational therapists and service providers in community organizations from three Quebec regions (n=16) were conducted. The group and individual interviews began with a presentation of data from studies in the field. This was followed by a discussion of the challenges of people with BPD in relation to job choice, performance, tenure, and the essential components to be included in an ideal intervention. Transcripts of the individual and group interviews were examined using content analysis. The components of the change and action models were validated by these same participants. Results The change model of the BIWI intervention addresses six themes, which seem appropriate to focus on for a population with BPD in the process of reintegration into the workplace: 1) meaning given to work; 2) self-awareness and sense of competence as a worker; 3) management of internal and external factors that affect mental workload; 4) interpersonal relationships in the work context; 5) disclosure of the mental disorder in the work context; and 6) more satisfying routines outside of work. The action model of BIWI reveals that this intervention is deployed in collaboration with health professionals from the public and private sectors and service providers from community or government agencies. It combines group (n=10 sessions) and individual meetings (n=2), in face-to-face and online modes. The prioritized outcomes are to reduce the number of perceived barriers to work reintegration and to improve mobilization towards a sustainable employment reintegration project. Conclusion Work participation is a pivotal target in the interventions for people with BPD. With the support of a logic model, it was possible to identify the key components to be considered in the schema of such an intervention. These components relate to central issues for this clientele, such as: their representations of work, self-knowledge as a worker, maintenance of performance and well-being at work, relations with the work group and external partners, and work embedded in one's occupational repertoire. These components are now included in the BIWI intervention. The next step will be to test this intervention with unemployed persons with BPD who are motivated to reintegrate the workforce.

Objectives This article aims at a critical study of the evolution of therapeutic measures in Swiss criminal law and of the ambiguous role that criminal justice let play to legal psychiatry in its decisions. Swiss law defines as criminal sanctions both sentences (punishment) and measures. Among the latter, a distinction must be drawn between therapeutic measures, aiming in principle at the treatment of the convicted person, and security measures, designed essentially to protect public security. Method To this end, after a brief presentation of the history of penal treatment measures in Switzerland, the status of measures in the criminal sanctions system is examined, presenting the range of different criminal measures and their evolution in time. Then, the relationship between mental health and justice, in particular the question of institutional treatment of mental disordered delinquents is analyzed, including the criticisms that it raises. Results The development of criminal measures over the last twenty years is characterized by two general trends: a strong decrease in the total number of criminal measures which have been ordered, and a sharp increase in the number of institutional therapeutic measures (Art. 59 CPS) to which offenders with serious mental disorders have been convicted. This latter increase is in line with a Swiss criminal security policy that is becoming more and more oriented towards risk management and marked by an obsession with the control of "high-risk offenders." In this logic, the primary aim of treatment for these offenders is supplanted by the aim of the protection of public security. This assumption is particularly tangible since therapeutic measures are not subject to a specific time limit and can be - and in practice are - regularly extended. This obsession with security is also crystallized in the difficult interaction between the judicial and the psychiatric worlds, since expertise is required for the pronouncement and the extension of a criminal measure. The system is criticized as well under a psychiatric as under a juridical point of view, and certain aspects have been recently condemned by the European Court of Human Rights. Conclusion We can observe that the use of the institutional therapeutic measure has increased, yet departing from its initial purpose, and obeying the movement towards more public security, even though the pronouncement of this measure is open to criticism. It rarely achieves its therapeutic objective, it is regularly submitted to prolongation, and it can lead to a measure of internment or a custodial sentence pronounced jointly, which run counter to the concrete needs of a person with mental health problems.

Objective The suicide mortality rate among people suffering from cluster B personality disorders is estimated at approximately 20%. High occurrence of comorbid depression and anxiety, as well as substance abuse, are known contributors to this risk. Not only have recent studies indicated that insomnia may be a suicide risk factor, but it is also thought to be highly prevalent in this clinical group. However, the mechanisms explaining this association are still unknown. It has been suggested that emotion dysregulation and impulsivity may mediate the link between insomnia and suicide. In order to better understand the association between insomnia and suicide in cluster B personality disorders, it is important to consider the influence of comorbidities. The aims of this study were first to compare the levels of insomnia symptoms and impulsivity between a group of patients with cluster B personality disorder and a healthy control group and second, to measure the relationships between insomnia, impulsivity, anxiety, depression, substance abuse and suicide risk within the cluster B personality disorder sample. Methods Cross-sectional study including 138 patients (mean age = 33.74; 58.7% women) with cluster B personality disorder. Data from this group were extracted from a Quebec-based mental health institution database (Signature bank: www.banquesignature.ca) and were compared to that of 125 healthy subjects matched for age and sex, with no history of personality disorder. Patient diagnosis was determined by diagnostic interview upon admission to a psychiatric emergency service. Anxiety, depression, impulsivity and substance abuse were also assessed at that time point via self-administered questionnaires. Participants from the control group visited the Signature center to complete the questionnaires. A correlation matrix and multiple linear regression models were used to explore relations between variables. Results In general, more severe insomnia symptoms and higher levels of impulsivity distinguished the group of patients with cluster B personality from the sample of healthy subjects, although groups did not differ on total sleep time. When all variables were included as predictors in a linear regression model to estimate suicide risk, subjective sleep quality, lack of premeditation, positive urgency, depression level and substance use were significantly associated with higher scores on the Suicidal Questionnaire-Revised (SBQ-R). The model explained 46.7% of the variance of scores at the SBQ-R. Conclusion This study yields preliminary evidence indicating the possible implication of insomnia and impulsivity in suicide risk for individuals with cluster B personality disorder. It is proposed that this association seems to be independent of comorbidity and substance use levels. Future studies may shed light on the possible clinical relevance of addressing insomnia and impulsivity in this clinical population.

Borderline personality disorder (BPD) is a common and severe disorder characterized by unstability of self-image, unstable affect, and unstable interpersonal relationships. Women with BPD would give birth as much as other women, but according to several studies, BPD mothers have a reduced sensitivity to their babies and a poor interpretation of their emotions; this would interfere in mother-baby interaction and in psycho-affective development of the baby, with the risk to develop psychiatric pathologies in adulthood. In this context several professionals have developed different interventions for mothers suffering from BPD. Objectives The main objective of this literature review is to list the interventions developed for BPD mothers during the perinatal period (from pregnancy to the 18 months of infant). The secondary objective is to assess the effectiveness of some of these interventions. Method We have screened five databases: PUBMED/MEDLINE, EMBASE, CINAHL, EBM REVIEWS and PSYCINFO, gray literature, recommendations of some countries, Google.ca website and OpenGray. We used keywords to screen the articles: Borderline personality disorder; Mothers, Women, Woman, Maternal, Perinatal, Perinatology, Postnatal, Postpartum, Pregnant, Pregnancy(ies), Infant(s), Infancy, Baby(ies), Newborn(s), Offspring(s), Young child, Young children. To be included, an article had to be written in English or French and published between 1980 and 2020 (a bibliographic watch was then carried out until December 2021); it had to deal with preventive and/or therapeutic intervention(s) targeting mothers suffering from BPD in the perinatal period. Results The search have generated 493 articles and 20 articles were selected. We have identified two main types of interventions: some are centered on the mother-baby dyad, others are centered only on the mother. Among them, there are therapies established for BPD patients in the general population, or specific mother-baby psychotherapies. Interventions are multidisciplinary, intervene early and intensively. Four articles have analysed the effectiveness of their program: according to the studies, the beneficial effects on dyadic interactions generally appear after several weeks of treatment, and for some programs the effects may persist over time; three authors show a reduction of maternal depressive symptoms. Only Australia and Switzerland have published recommendations targeting BPD mothers in the perinatal period. Conclusion Interventions with BPD mothers in the perinatal period can be based on reflexives theoreticals models or be in connection with the emotional dysregulation from which these mothers suffer. They must be early, intensive and multi-professional. Given the lack of studies that have analysed the efficacy of their programs, no intervention currently stands out, so it seems important to continue the investigations.

Objectives The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes an Alternative Model for Personality Disorders (DSM-5), which defines personality disorders based on two dimensional criteria. Criterion A corresponds to the severity of personality dysfunction in the areas of self and interpersonal functioning, while Criterion B comprises five pathological domains including a total of 25 facets. Six specific disorders, including borderline personality disorder (BPD), are defined in the AMPD based on Criteria A and B. However, there is currently very little data on these diagnoses as they are operationalized in the MATP. This study aims to present data on this recent operationalization of BPD. More specifically, we will first introduce a procedure, based on self-reported questionnaires covering the two main MATP criteria, implemented to generate the BPD diagnosis from the AMPD. Then, we will assess its validity (a) by documenting its prevalence in a clinical sample; (b) by determining its degree of correspondence with the "traditional" BPD categorical diagnosis and with a dimensional measure of borderline symptomatology; (c) by presenting convergent validity data with constructs relevant to the study of BPD (impulsivity, aggression); and (d) by determining the incremental validity of the proposed procedure in contrast with a simplified approach where only Criterion B would be considered. Method Data from 287 patients recruited as part of the admission process at the Centre de traitement le Faubourg Saint-Jean of the CIUSSS-Capitale-Nationale were analyzed. The BPD diagnosis from the MATP was generated based on two validated self-report questionnaires, in their French version, namely the Self and Interpersonal Functioning Scale (Criterion A) and the Personality Inventory for DSM-5-Faceted Brief Form (Criterion B). Results The BPD diagnosis, as operationalized in the AMPD, had a prevalence of 39.7% in the sample. A moderate fit with the clinician's diagnosis of BPD according to the traditional DSM-5 categorical model was observed, as well as a strong correlation with a dimensional measure of borderline symptomatology. Nomological network analysis revealed high and theoretically expected correlations between the disorder and measures of aggression and impulsivity. The proposed diagnostic extraction procedure, which uses Criteria A and B, showed incremental validity in the statistical prediction of external variables (borderline symptomatology, aggression, impulsivity) compared to a simplified procedure using only Criterion B. Conclusions The proposed procedure for generating the BPD diagnosis according to the MATP definition yields promising results and could allow screening for the disorder based on this contemporary conceptualization of personality pathologies.