Acta psychiatrica Belgica最新文献

The history of the concept of depression is briefly reviewed. First described under the name of melancholia as a delusional state, then, since Esquirol, as a primary mood disorder, it was subdivided by Kraepelin in diseases characterised by an hypothetical etiology and is considered, since 1980, as a syndrome with many sub-varieties. The nature of the three possible models is discussed. The first two, until now used, which considered depression either as a disease or as a syndrome, are categorical. The first has been provisorily abandoned, due to the insufficiency of scientific proofs about the etio-pathogeny; the second, despite its growing complexity, is obviously not satisfactory. The third model, dimensional, which attracts a growing attention in other field of psychiatric nosology, offers for the time being a possible alternative.

Our study is based on a puppet theatre performed with a group of children aged from six to eight who were experiencing a neurotic context. Guignol's playing reveals anguishes and defensive mechanisms as well as, regarding the actors, the ability to experience the comedy with authenticity without forgetting it is imaginary. The puppet theatre has allowed us to progress in a therapeutic process while continuing diagnostic exploration.

The influence of several socioeconomic factors in return to work following myocardial infarction has been evaluated for 55 male patients. Age, employment status and educational level are among the most determinant factors. Whereas, the financial resources appear less significant as an incentive to resumption of work.

This paper reviews and comments the literature related to the problems families have to deal with when cancer occurs, in a psychological and relational perspective. It addresses, among other topics, communication problems and the specific aspects of the different evolutional phases of the disease, and the subsystems of the family. Considering the dramatic effects of cancer within the family and the interdependency of the patient and his family in their adjustment to the disease, we propose that psychological evaluation and support should be offered to the family system as a whole.

This article attempts to give an overview of the main cognitive-behavioral therapeutic approaches in order to reduce persistent, unpleasant and drug-resistant auditory hallucinations. These procedures are based on operant conditioning principles and cognitive self-management techniques. A brief case history is reported to illustrate the therapeutic interventions.

This paper is about a therapeutic group created 3 years ago in our psychiatric day care unit: the genogram group. We will explain first how was born the idea of a work based on familial history and relationship, and how it was organised in practice. Then, we will speak about genogram interpretation and the different themes that the genogram can reveal: the nuclear family, the familial culture (her myths, her repeating model), the familial life cycle. We will also expose the theoretical models on which are based these themes. Finally, we will present our observations based on the experience with this group and about the characteristics and advantages of his use in institution.

Cerebral frontal glucose metabolism was investigated in 12 unipolar depressed patients and compared to these of 12 healthy volunteers using Positron Emission Tomography (PET) and (F18) fluorodeoxyglucose. The PET investigation was made in a quiet room with a dimly light and each subject remained in a resting state with closed eyes. Results show a decreased in a frontal superobasal calculated ratio in depressed patients compared to control subjects for left and for right values. This reduction indicates an imbalance between the frontal and the superobasal region. This imbalance could relate to some particular depressive symptom profile.

Epidemiological data about depression in Africa are contradictory. Until the fifties, an almost absence of depression was reported in the studied population and from the fifties till today, a prevalence comparable to these of others continents is found. The authors discussed methodological and technical grounds susceptible to explain this controversy, with a special focus on cultural factors according to the parental and way of thinking of the Kongos in Zaïre.

The current main neurochemical theories of the biological correlates of suicidal behavior principally involve the serotonergic system. Few data are available about the possible role of the catecholaminergic (noradrenergic and dopaminergic) function. In the present study, in a first part, we assessed the growth hormone (GH) response to clonidine, a selective alpha 2-adrenergic agonist, and to apomorphine, a dopaminergic agonist, in 22 DSM-III-R major depressive male inpatients with a history of suicide attempts compared to 22 age-matched major depressive inpatients without history of suicidal behavior. Hormonal responses to clonidine and apomorphine were also compared with 4.00 PM postdexamethasone cortisol levels. The two groups differed significantly in the GH peak response after apomorphine: 6.27 +/- 3.18 ng/ml in suicide attempters vs 17.40 +/- 14.87 ng/ml in nonattempters (F = 11.78, p = 0.001). There was no statistically significant difference between the two groups for GH peak responses after clonidine. Moreover, mean postdexamethasone cortisol levels did not exhibit any significant difference between suicide attempters and nonattempters. Violent and nonviolent attempters did not differ on any of the biological measures. In a second part, P300 and contingent negative variation (CNV) were recorded in 20 depressive inpatients subgrouped into suicide attempters (n = 10) and nonattempters (n = 10). The results showed a significant reduction of both P300 and CNV amplitudes in patients who attempted suicide compared to patients without history of suicide attempts. Moreover, a significant correlation was found between the Suicidal Risk scale and CNV amplitude. In conclusion, these results suggest that a dopaminergic hypoactivity as assessed by a blunted GH response to apomorphine and by a reduction of both P300 and CNV amplitudes, could be considered as a biological correlate of suicidal behavior. In contrast, noradrenergic disturbances, particularly at the level of alpha 2-adrenergic receptors, seem to play a more minor role. Moreover, DST nonsuppression cannot be considered as a biological marker of suicidal behavior.

The application of the 06-26-1990 law for the protection of mentally ill persons has confronted the psychiatrists working in general psychiatry wards with the problem of keeping up patients hospitalized against their own will and following a judiciary authority decision. Having to deal with this problem, the authors first reviewed the literature about the use of restraint techniques in psychiatry. They observed that these universally used techniques were strikingly denied in the psychiatric literature so that their accurate application was made difficult because of the lack of information about their indications, contra-indications and application modalities. Afterwards, the authors have compared the different restraint techniques in a retrospective study over a one year period among voluntarily hospitalized patients and patients admitted against their wil in application of the 06-26-1990 law. They reported that the application of the law undoubtedly increased the number of restraint but did not modify either the population characteristics of the treatment modalities. These results have to be further confirmed in a prospective study.