Acta psychiatrica Belgica最新文献

The author approaches ethical questions raised by use of methadone in opiates addiction: reduction of drug phenomenon to a strict medical problem, illusion of technical mastery, responsibility of pharmaceutical engineering, medicine under repressive constraint, reduction of damages linked to prohibition. The communication ends on a question about management of drug problems which today encourages a healthy vision of consumption behaviour rather than a "good way of use".

The psychotherapeutical relationship is part of the communication sciences. Therefore some authors as e.g. J. Habermas consider the ethics of the psychotherapeutical relationship to be paradigmatical for the ethics of communication. The ethical problems of psychotherapy are particularly important, since the patient-psychotherapist relationship is the main instrument of therapy. The ethical problems vary according to the type of psychotherapeutical relationship, which in turn depends on the form of psychotherapy. Therefore the ethical problems will successively be considered in the psychoanalytically oriented psychotherapies, the behavior therapies and the systemic therapies. Finally the more general ethical problem of the relations of psychotherapists with power will be discussed.

The psychiatrists who appear in commercial films can roughly be divided into 3 stereotyped categories: 1. The funny and foolish character who lacks all common sense. He often is more deranged than his patients, but in a harmless way. 2. The intelligent, attractive, modest, warm, etc. psychiatrist who devotes his time and life to the well-being of his patients. He is too perfect to be true and is usually a rather boring character. 3. The thoroughly evil psychiatrist, who abuses his power for his personal ambition or enrichment. He endangers the health and life of his patients with his outrageous treatments and experiments. He is a classical horror movie character. Some of the implications that these prejudiced representations in popular culture have on the doctor-patient relationship will be discussed.

All the theories of mind used in the treatment of mental illnesses are based on one or another kind of determinism. Therefore, psychiatrists are obliged to conceive the subjective free will of their patients as a psychological function that their theories do not explain. As a result of it, they encounter many difficulties in the ethical aspects of their therapeutical choices. Following the ideas of A. Pichot, F. Varela and Ph. Meire, the author proposes an autoreferential conception of the cerebral functions and its link with mind. He shows how it is possible to give a theoretical place to human free will. He indicates the clinical advantages of such a model, giving the free will of the patient a therapeutical role, and making the ethical choices of the psychiatrist easier.

This article is based on observations and thoughts during intensive psychotherapeutic work with 997 sexually abused children and their parents after they had been reported to the Confidential Doctor Center Kind in Nood of the VUB (between 1986 and 1994). Without denying the existence of sexual abuse of children, it is important not to exaggerate this phenomena, which can be described as the Child Sexual Abuse Panic Syndrome. Doing this only gives way to denial and indignation or scandalization and revenge, and certainly does not lead to a clear analysis of the problem. Accurate observation enables some existing myths to become unravelled: abusive fathers are seldom power robots, mothers are not always warm-hearted, innocent creatures and children are not black boxes without feeling and sexual desires. The underlying message is about the bitter fight against modernization of sexuality, which seems again experienced as dangerous. However it is fear for a free, adult sexuality that is at the core of sexual exploitation of children, which should encourage caution in professional answers to this delicate issue.

In a cross-sectional study of 117 randomly selected patients (52 men, 65 women) with definite multiple sclerosis, it was found that 76 percent were married or cohabitant, 8 percent divorced. Social contacts remained unchanged for 70 percent, but outgoing social contacts were reduced for 45 percent. Ninety-five percent lived in own house or flat and 70 percent received disablement pension. More than half of the patients (56.4 percent) were dependent on help from close relatives, most frequently spouse. The need for help, the risk of divorce, loss of contact with relatives, difficulty in going out, need for structural changes in home and need for pension became greater with increasing physical handicap. No significant differences between gender were found. It is concluded that patients and relatives are under increased social strain, when multiple sclerosis progresses to a moderate handicap (Kurtzke Disability Rating Scale, 3-5).

The authors describe by turns their experience about indigenous medicine in Senegal, in New-Caledonia and in Nepal. They show that these indigenous medicines have common fundamental characteristics, although these various cultures are not linked together by their history. They compare these ways of thinking with occidental scientific medicine, and with the way of thinking of psychoanalysis.

We described a case of "folie à deux" in a wife husband couple. We observed the syndrome gradually developing while following the husband in therapy for others reasons. Psychodynamic hypothesis for the occurrence and function of the disorder in this couple are discussed.

The present article reviews the basic and recent findings of the genetics in manic-depressive illness. The different molecular genetic techniques that have been applied to this research field are presented. Results of linkage and association studies are discussed in regard to the main limitations of these approaches in psychiatric disorders. On the whole, linkage and association studies contributed to the localisation of some potentials vulnerability genes for manic-depression on chromosome X and 11 and more recently 18.