Annales medico-psychologiques最新文献

Determining medical fitness for service in the armed forces is one of the missions of the military health service, which is well acquainted with the different situations in which soldiers are deployed. Medico-psychological expertise in a military environment requires a thorough knowledge of psychiatric pathology, of soldiers’ psychopathology, environmental constraints and regulatory standards specific to each specialty. It is today the responsibility of the medical officers, who can call on the support of specialists from psychiatric wards in military hospitals, with a twofold mission of providing care and assessing fitness for duty.

Is research necessary for psychiatric care? On the contrary, could it prove to be counter-productive, reducing the scope of the field by the reductionism inherent in its methodology? This article examines the specific features of care in psychiatry, from the point of view of the history of our discipline and its close links with both clinical and fundamental research. Its main lines of development are then detailed, viewed through the lens of the ethical and epistemological challenges facing the discipline, in terms of their impact on care, and the compatibility between the question of care, and that of the quest for knowledge. The very essence of the former being to look after the subject's well-being, whereas that of the latter is often aimed primarily at the collective interest and indirectly at individual care, without necessarily guaranteeing it.

Objectives

During the sixties, the important development of psychotherapies gave rise to great expectations for the treatment of psychoses. Are those days over or are there still publications that support the place and effectiveness of psychoanalytically-inspired psychotherapies?

Material and methods

Bibliographical research was carried out focusing on the 15-year period from 2005 to 2020 using Pubmed, Scopus, Psycart, and Cairninfo, and with the keywords: psychodynamics and psychosis or schizophrenia, psychoanalysis and schizophrenia or psychosis, Articles dealing only with theoretical issues related to psychoses or schizophrenia were excluded.

Results

By excluding meta-analyses, all of which have moreover shown at best a discrete effectiveness of cognitive-behavioral therapies, we retained 63 articles, 26 of which with the word psychoanalysis. This observation alone is indicative of the lack of publications addressing these themes with fewer than 5 publications per year at the international level! As far as effectiveness studies are concerned, the results are even rarer: We found 11 studies among the 63 selected articles. Only two of these studies used a control group and standardized scales. The need for standardization has resulted in the creation of a simplified form of psychotherapy, “Supportive Psychoanalytic Psychotherapy”.

Conclusion

The pressure to demonstrate efficiency rather than effectiveness has prevailed over psychoanalytic psychotherapies in the treatment of psychoses. However, that is probably not the only reason. The complexity of the theory of psychoses and the lack of synthesis works render its transmission difficult. If we do not want all the theoretical advances that have been made to be lost, we must ensure that the teaching of these theories be more specific and synthetic. Similarly, we need to launch longer-term studies so that a sufficient duration of treatment allows for a real evaluation of the efficiency of these therapies.

Objectives

To outline the procedure for obtaining reimbursement by the French National Health system for psychotherapy provided by private practitioners.

Method

By conducting a review of scientific literature, reports, plans, and governmental decisions.

Results

Some twenty years have passed since a recommendation was included in the “plan of action for the development of psychiatry and the promotion of mental health”, which was drafted in 2003. The contribution of epidemiology applied to psychotherapeutic practices in France, and comparisons with neighboring countries, highlighted the quantitative importance of the role of psychiatrists (they provide more than half of all psychotherapeutic interventions) in the implementation of the plan of action, including in the least endowed areas of the country. The 2010 decree on the use of the title of psychotherapist was an essential preliminary step, since, previously, no requisite training was required for that title, which involved substantial risk. Henceforth, fundamental and clinical knowledge have been imposed with mandatory limits of duration. Subsequently, the publication of high expenditures on mental health by the French National Health Program coupled with the establishment of the reimbursement for psychotherapy in the United Kingdom, resulted in a promising French medico-economic study as well asan experiment in four departments involving patients between the ages of 18 and 60 who were suffering from mild and moderate anxious and depressive disorders. The diagnoses were based on PHQ9 and GAD7 being applied by the general practitioner, excluding the most severe cases, which allowed them to provide their patients with an evaluation session by an office-based psychologist followed by 10 sessions of “supportive therapy”. In the case of no improvement, an evaluation by a psychiatrist was required before providing 10 additional “structured therapy” sessions. After a two-year evaluation period, the process was determined to be beneficial for patients, general practitioners, and the psychologists who were involved. This led to the establishment, in 2022, of an on-line platform labeled “Mon Parcours Psy” (My Psychiatric Path) which facilitates the payment for 8 sessions per year of psychotherapy treatment for minor disorders for patients as young as 3 years of age., Parental authorization is required for minors.

Discussion

The prescription of psychotherapy by general practitioners for mild or moderate disorders and the price of services provided by psychologists have been the object of criticism by the members of this profession: both the quantity of prescriptions and the tariffs for such services were deemed to be too low.

Conclusions

Making psychotherapy provided by psychologists available to the public at large, thanks to the introduction of a system to cover the costs involved by the