Pub Date : 2024-04-01DOI: 10.1016/j.amp.2024.01.010
Carole Damiani
Today, care and support systems for victims of violent events are composed, from the very beginning of the emergency, of medico-psychological caregivers and legal experts. Although closely intertwined, psychological care and reparation fall into two different fields: the clinical and the legal. Some terms have clearly differentiated meanings while others, using similar terms, cover very different realities. Furthermore, the use of the expressions “victim”, “trauma” and “reparation” following a violent event has become so wide spread that they have lost all specificity. We therefore feel it is fundamental to define these terms in each of their respective fields. Secondly, we will attempt to differentiate between care and reparation, so as not to maintain the confusion between what lies in the legal realm or in the psychological reality. Legal experts and psychotherapists can only improve their practices if each maintains their respective place while liaising, establishing the necessary continuity between what unites people and what makes them different, distinctions that at times become blurred, or that come dangerously close?
{"title":"Soins et réparation. Les liaisons dangereuses ?","authors":"Carole Damiani","doi":"10.1016/j.amp.2024.01.010","DOIUrl":"10.1016/j.amp.2024.01.010","url":null,"abstract":"<div><p>Today, care and support systems for victims of violent events are composed, from the very beginning of the emergency, of medico-psychological caregivers and legal experts. Although closely intertwined, psychological care and reparation fall into two different fields: the clinical and the legal. Some terms have clearly differentiated meanings while others, using similar terms, cover very different realities. Furthermore, the use of the expressions “victim”, “trauma” and “reparation” following a violent event has become so wide spread that they have lost all specificity. We therefore feel it is fundamental to define these terms in each of their respective fields. Secondly, we will attempt to differentiate between care and reparation, so as not to maintain the confusion between what lies in the legal realm or in the psychological reality. Legal experts and psychotherapists can only improve their practices if each maintains their respective place while liaising, establishing the necessary continuity between what unites people and what makes them different, distinctions that at times become blurred, or that come dangerously close?</p></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0003448724000428/pdfft?md5=dd7c4066b985b00f6b431ff51f7fe809&pid=1-s2.0-S0003448724000428-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140465653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.amp.2023.11.009
Eloïse Maakaron , Bérengère Saliba-Serre , Nicole Cano , Pierre Le Coz , Thierry Merrot
Objectives
This article focuses on the ethical issues surrounding gender-affirming care for transgender people (i.e. A person whose gender does not correspond to their sex assigned at birth), particularly the respect of the rights of transgender patients to autonomy during psychiatric evaluations. This topic gives leave to a deeper investigation into the principles of non-maleficence when diagnosing gender dysphoria and into the principles of justice when providing essential medical care for transgender people in France.
Materials and methods
Firstly, a review of the literature was carried out in order to explore the historicity of sex, its definition and variations, and the concept of gender identity. To establish the latter's relationship to psychiatry, the evolution of gender dysphoria through psychiatric classifications and guidelines was reviewed, as well as the role of the psychiatrist in the process of gender-affirming treatment. A reflection was also carried out concerning the ethical issues of the medical care of trans people, through the autonomy of choice, beneficence and non-maleficence of access to the hormonal-surgical transition, and the societal issues involved in the evolution of the consideration of gender. A study was conducted via a websurvey and a questionnaire was sent to psychiatric residents completing their studies in France. A total of 70 respondents were included. The questionnaire asked residents to give their opinion on transgender people's right to autonomy (and how to respect them) during psychiatric assessments and psychological inputs.
Results
The answers from the residents indicate that they are mainly in favor of upholding transgender people's right to autonomy, with an emphasis on their capacity and their right to self-determination. Conversely, 15% of the respondents viewed transgender identities as a mental disorder and were more in favor of a medicalized model of treating gender dysphoria. A psychiatric assessment prior to receiving gender-affirming care was still perceived as necessary in order to eliminate differential diagnoses and to evaluate the capacity for informed consent, however, this may be perceived as excessive pathologization for transgender people. On the other hand, this feeling of pathologization is perceived as diminished if this consultation is performed by a psychologist. These answers suggest the necessity of carrying out a comparison with the feelings of the concerned individuals, for a more ethical management of transidentity.
Conclusion
The issue of meeting the demands of the transgender population is still being debated. It is legitimate to ask whether we can, under cover of their freedom of choice, let the persons concerned make the decision without having first undergone a medical evaluation, and whether the individual's autonomy must take precedence over potential irreversible negative outco
{"title":"Transidentité et dépsychiatrisation : enjeux éthiques. Enquête nationale auprès des psychiatres en formation","authors":"Eloïse Maakaron , Bérengère Saliba-Serre , Nicole Cano , Pierre Le Coz , Thierry Merrot","doi":"10.1016/j.amp.2023.11.009","DOIUrl":"10.1016/j.amp.2023.11.009","url":null,"abstract":"<div><h3>Objectives</h3><p>This article focuses on the ethical issues surrounding gender-affirming care for transgender people (i.e. A person whose gender does not correspond to their sex assigned at birth), particularly the respect of the rights of transgender patients to autonomy during psychiatric evaluations. This topic gives leave to a deeper investigation into the principles of non-maleficence when diagnosing gender dysphoria and into the principles of justice when providing essential medical care for transgender people in France.</p></div><div><h3>Materials and methods</h3><p>Firstly, a review of the literature was carried out in order to explore the historicity of sex, its definition and variations, and the concept of gender identity. To establish the latter's relationship to psychiatry, the evolution of gender dysphoria through psychiatric classifications and guidelines was reviewed, as well as the role of the psychiatrist in the process of gender-affirming treatment. A reflection was also carried out concerning the ethical issues of the medical care of trans people, through the autonomy of choice, beneficence and non-maleficence of access to the hormonal-surgical transition, and the societal issues involved in the evolution of the consideration of gender. A study was conducted via a websurvey and a questionnaire was sent to psychiatric residents completing their studies in France. A total of 70 respondents were included. The questionnaire asked residents to give their opinion on transgender people's right to autonomy (and how to respect them) during psychiatric assessments and psychological inputs.</p></div><div><h3>Results</h3><p>The answers from the residents indicate that they are mainly in favor of upholding transgender people's right to autonomy, with an emphasis on their capacity and their right to self-determination. Conversely, 15% of the respondents viewed transgender identities as a mental disorder and were more in favor of a medicalized model of treating gender dysphoria. A psychiatric assessment prior to receiving gender-affirming care was still perceived as necessary in order to eliminate differential diagnoses and to evaluate the capacity for informed consent, however, this may be perceived as excessive pathologization for transgender people. On the other hand, this feeling of pathologization is perceived as diminished if this consultation is performed by a psychologist. These answers suggest the necessity of carrying out a comparison with the feelings of the concerned individuals, for a more ethical management of transidentity.</p></div><div><h3>Conclusion</h3><p>The issue of meeting the demands of the transgender population is still being debated. It is legitimate to ask whether we can, under cover of their freedom of choice, let the persons concerned make the decision without having first undergone a medical evaluation, and whether the individual's autonomy must take precedence over potential irreversible negative outco","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139539007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.amp.2024.01.011
Jokthan Guivarch
Neglect is the most common form of child abuse. It can also have the most serious impact on a child's development, with an increased and accompanying risk of the emergence of psychiatric disorders from adolescence to adulthood. Child neglect is under-recognized today, due to a lack of training for professionals, the orientation of child psychiatry, and difficulties in understanding what this vague concept refers to. After proposing definitions of neglect, its characteristics, and its effects, we present the possible actions of the child psychiatrist in the ecosystem of the neglected child. Neglect is neither a legal nor a medical term. It is, however, used by doctors and social workers, with a loose definition as the absence of appropriate care for a child's development. Neglect is multifactorial. The French consensus approach to the basic needs of the child has highlighted a meta-need for security, emphasizing attachment and the particular qualities of the caregiver. In light of this report, we understand that affective or emotional neglect is the most problematic form of neglect. The effects of neglect are early, depending on the child's age. They can manifest as developmental delays, sleep disorders, tonus disorders in infants, intellectual disorders, and various internalized and externalized disorders in adolescence. Mortality and morbidity are increased in cases of neglect, and developmental sequelae have been described. Neglect has a greater impact on development than physical abuse. The child psychiatrist can take three types of action to treat the neglected child. Firstly, he or she must identify neglect and alert the appropriate instances so as to protect the child. Identification involves being aware of indicators of neglect and a particular clinical pattern that varies according to age, requiring the exploration of the different lines of development. Three clinical patterns seem to be linked to extreme neglect: anaclitic depression, post-traumatic stress disorder, particularly complex developmental trauma, and attachment disorders. When faced with symptoms suggestive of neglect, the child psychiatrist should try to rule out a sensory or neurodevelopmental cause, sometimes seeking the advice of a specialist. He or she will observe the child's behavior alone and with his or her parents, as well as parent-child relationships, and will consider the child outside the family microsystem in an ecosystemic approach. The child psychiatrist can use available standardized tools that explore the various dimensions of neglect. This multi-consultation assessment should not delay the child psychiatrist's initial actions, given the narrow developmental windows. In particular, the child psychiatrist may be required to report the child's situation to the administrative and judicial authorities. The care provided to the neglected child will then take place within the child's own ecosystem. Interventions must be early, participative and in partner
{"title":"Place du pédopsychiatre auprès de l’enfant négligé","authors":"Jokthan Guivarch","doi":"10.1016/j.amp.2024.01.011","DOIUrl":"10.1016/j.amp.2024.01.011","url":null,"abstract":"<div><p>Neglect is the most common form of child abuse. It can also have the most serious impact on a child's development, with an increased and accompanying risk of the emergence of psychiatric disorders from adolescence to adulthood. Child neglect is under-recognized today, due to a lack of training for professionals, the orientation of child psychiatry, and difficulties in understanding what this vague concept refers to. After proposing definitions of neglect, its characteristics, and its effects, we present the possible actions of the child psychiatrist in the ecosystem of the neglected child. Neglect is neither a legal nor a medical term. It is, however, used by doctors and social workers, with a loose definition as the absence of appropriate care for a child's development. Neglect is multifactorial. The French consensus approach to the basic needs of the child has highlighted a meta-need for security, emphasizing attachment and the particular qualities of the caregiver. In light of this report, we understand that affective or emotional neglect is the most problematic form of neglect. The effects of neglect are early, depending on the child's age. They can manifest as developmental delays, sleep disorders, tonus disorders in infants, intellectual disorders, and various internalized and externalized disorders in adolescence. Mortality and morbidity are increased in cases of neglect, and developmental sequelae have been described. Neglect has a greater impact on development than physical abuse. The child psychiatrist can take three types of action to treat the neglected child. Firstly, he or she must identify neglect and alert the appropriate instances so as to protect the child. Identification involves being aware of indicators of neglect and a particular clinical pattern that varies according to age, requiring the exploration of the different lines of development. Three clinical patterns seem to be linked to extreme neglect: anaclitic depression, post-traumatic stress disorder, particularly complex developmental trauma, and attachment disorders. When faced with symptoms suggestive of neglect, the child psychiatrist should try to rule out a sensory or neurodevelopmental cause, sometimes seeking the advice of a specialist. He or she will observe the child's behavior alone and with his or her parents, as well as parent-child relationships, and will consider the child outside the family microsystem in an ecosystemic approach. The child psychiatrist can use available standardized tools that explore the various dimensions of neglect. This multi-consultation assessment should not delay the child psychiatrist's initial actions, given the narrow developmental windows. In particular, the child psychiatrist may be required to report the child's situation to the administrative and judicial authorities. The care provided to the neglected child will then take place within the child's own ecosystem. Interventions must be early, participative and in partner","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139882048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The debate about unconventional healthcare practices and their possible integration into conventional medical care presents an inexhaustible subject of polemics and controversy, particularly in France. In this debate, some prefer to openly deny its complexity in favor of simplistic rhetoric: these are the pro- and anti-unconventional medicine activists. Their radical rhetoric provides an ideal realm of discussion in which to analyze the cognitive shortcuts and other reasoning biases they employ. An initial analysis of the arguments put forth by the antis reveals an asymmetry in the use of the critical thinking they claim: the latter is applied to so-called “pseudo-medicine” and very little to their “rationalist” arguments.
Method
In this article, we have chosen to compensate for this shortcoming by providing a critical analysis of the 10 most common “rationalist sceptic” arguments used by opponents of complementary medical practices put forth in the press and media. Given the caricatural nature of certain skeptical positions, we have chosen to use satire and caricature ourselves for didactic purposes. Each of the 10 arguments is presented as follows: 1) a summary of the radical assertion being defended, followed by 2) the partial arguments or rhetorical strategy put forward to justify it, and 3) the counterarguments which are more or less deliberately kept silent.
Results
We present a short caricatural summary of this argument: “Breaking news in the field of health care! Wired therapies are attempting to invade real medicine! We, rationalist physicians and defenders of true medicine, are concerned about the development of integrative medicine in France. We are sending this 10-point skeptical rationalist argument to the entire medical community and health professionals in order to put a stop to the development of integrative medicine and protect real medicine from heretics. We challenge every health care professional to take a stand; scientific medicine represents Good, because the Truth is on our side and the evidence guides our steps. If there were any evidence in favor of complementary and integrative medicine, we would be aware of it. In fact, these proponents are nothing more than charlatans whose claims are groundless. Let's be serious and proud to be Cartesian, because our country still stands up to all these would-be crooks. This proposal is based on the values of critical thinking, which aims to fight against misinformation in medicine and more generally in science. We have endeavored, as much as possible, to anticipate the objections that might be raised against our arguments.” We then analyze each argument separately.
Discussion
In the last part of our article, we analyze in greater detail the main cognitive biases used in the 10 arguments cited, drawing on the tools of metacognition: confirmation bias, framing bias and overconfidence bias
{"title":"« Il est urgent de contrer le développement de la médecine intégrative et de sauver la vraie médecine ». Analyse critique de dix arguments rationalistes sceptiques","authors":"Fabrice Berna , Laurent Lecardeur , Laurence Verneuil , Julien Nizard , Renaud Evrard","doi":"10.1016/j.amp.2023.07.003","DOIUrl":"10.1016/j.amp.2023.07.003","url":null,"abstract":"<div><h3>Context</h3><p>The debate about unconventional healthcare practices and their possible integration into conventional medical care presents an inexhaustible subject of polemics and controversy, particularly in France. In this debate, some prefer to openly deny its complexity in favor of simplistic rhetoric: these are the pro- and anti-unconventional medicine activists. Their radical rhetoric provides an ideal realm of discussion in which to analyze the cognitive shortcuts and other reasoning biases they employ. An initial analysis of the arguments put forth by the antis reveals an asymmetry in the use of the critical thinking they claim: the latter is applied to so-called “pseudo-medicine” and very little to their “rationalist” arguments.</p></div><div><h3>Method</h3><p>In this article, we have chosen to compensate for this shortcoming by providing a critical analysis of the 10 most common “rationalist sceptic” arguments used by opponents of complementary medical practices put forth in the press and media. Given the caricatural nature of certain skeptical positions, we have chosen to use satire and caricature ourselves for didactic purposes. Each of the 10 arguments is presented as follows: 1) a summary of the radical assertion being defended, followed by 2) the partial arguments or rhetorical strategy put forward to justify it, and 3) the counterarguments which are more or less deliberately kept silent.</p></div><div><h3>Results</h3><p>We present a short caricatural summary of this argument: “Breaking news in the field of health care! Wired therapies are attempting to invade real medicine! We, rationalist physicians and defenders of true medicine, are concerned about the development of integrative medicine in France. We are sending this 10-point skeptical rationalist argument to the entire medical community and health professionals in order to put a stop to the development of integrative medicine and protect real medicine from heretics. We challenge every health care professional to take a stand; scientific medicine represents Good, because the Truth is on our side and the evidence guides our steps. If there were any evidence in favor of complementary and integrative medicine, we would be aware of it. In fact, these proponents are nothing more than charlatans whose claims are groundless. Let's be serious and proud to be Cartesian, because our country still stands up to all these would-be crooks. This proposal is based on the values of critical thinking, which aims to fight against misinformation in medicine and more generally in science. We have endeavored, as much as possible, to anticipate the objections that might be raised against our arguments.” We then analyze each argument separately.</p></div><div><h3>Discussion</h3><p>In the last part of our article, we analyze in greater detail the main cognitive biases used in the 10 arguments cited, drawing on the tools of metacognition: confirmation bias, framing bias and overconfidence bias","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83340485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.amp.2023.04.017
Louis Ledeuil , Renaud Evrard
Objective
“Self-help” refers to a heterogeneous collection of syncretic knowledge, delivered in the form of books, videos or training courses. This content is sought after by many people whose obvious objective is the quest for an authentic self, in a society where identity supports are wavering. In addition to being a critical consideration, our study aims to better understand the motivations of those who invest in this knowledge and who feed their preferences for these non-conventional approaches.
Method
Within the framework of a literature review in the form of clinical anthropology, three clinical vignettes are presented, based on clinical research interviews conducted with volunteers engaged in a personal development process.
Results
One of the participants is involved in a practice that includes two mentors; another pursues only a reflective approach nourished by his readings; and the last one supplements his readings with psychological consultations. All of them pursue a desire for inner transformation in connection with a questioning of identity.
Discussion
Reading such works can promote forms of symbolization mediated by reading. The first vignette provides a clinical illustration of the concept of “apérité” developed by Nicolas Marquis. It demonstrates that the possibility for the subject to identify himself with the contents of the self-help book, which allows him to develop new representations, linked to his personal life history, thereby helping him to move towards a clearer representation of his internal world and the functioning of his identity. The second subject is more motivated by the hope of the existence of an ideal of life that he could implement with the help of the concrete application of certain key factors. He is trying to rebound from a complex family situation that has pushed him to break with his family. By adopting a self-help approach, he is attempting to find the support and backing that he did not have in his family environment. The identification with mentors constitutes a support comparable to a religious precept. The practice of mentoring embodies a real system of reference and support in the life of the third subject interviewed. Over time, this practice enabled him to establish a new relationship with his parents and to gradually emancipate himself. The mentor is often assigned to accompany the individual in the development of a mindset that favors his or her empowerment. This practice also underpins a path towards self-awareness, by inviting the subject to consciously reconnect with his internal world and the different sensations that run through it at various moments of daily life. From the perspective of the participants in the study, personal development stimulates a self-therapeutic work whose limits are exceeded by a gradual openness towards another, in a process of therapeutic pre-commitment.
{"title":"Dimensions auto-curatives et pré-engagement thérapeutique du « développement personnel »","authors":"Louis Ledeuil , Renaud Evrard","doi":"10.1016/j.amp.2023.04.017","DOIUrl":"10.1016/j.amp.2023.04.017","url":null,"abstract":"<div><h3>Objective</h3><p>“Self-help” refers to a heterogeneous collection of syncretic knowledge, delivered in the form of books, videos or training courses. This content is sought after by many people whose obvious objective is the quest for an authentic self, in a society where identity supports are wavering. In addition to being a critical consideration, our study aims to better understand the motivations of those who invest in this knowledge and who feed their preferences for these non-conventional approaches.</p></div><div><h3>Method</h3><p>Within the framework of a literature review in the form of clinical anthropology, three clinical vignettes are presented, based on clinical research interviews conducted with volunteers engaged in a personal development process.</p></div><div><h3>Results</h3><p>One of the participants is involved in a practice that includes two mentors; another pursues only a reflective approach nourished by his readings; and the last one supplements his readings with psychological consultations. All of them pursue a desire for inner transformation in connection with a questioning of identity.</p></div><div><h3>Discussion</h3><p>Reading such works can promote forms of symbolization mediated by reading. The first vignette provides a clinical illustration of the concept of “apérité” developed by Nicolas Marquis. It demonstrates that the possibility for the subject to identify himself with the contents of the self-help book, which allows him to develop new representations, linked to his personal life history, thereby helping him to move towards a clearer representation of his internal world and the functioning of his identity. The second subject is more motivated by the hope of the existence of an ideal of life that he could implement with the help of the concrete application of certain key factors. He is trying to rebound from a complex family situation that has pushed him to break with his family. By adopting a self-help approach, he is attempting to find the support and backing that he did not have in his family environment. The identification with mentors constitutes a support comparable to a religious precept. The practice of mentoring embodies a real system of reference and support in the life of the third subject interviewed. Over time, this practice enabled him to establish a new relationship with his parents and to gradually emancipate himself. The mentor is often assigned to accompany the individual in the development of a mindset that favors his or her empowerment. This practice also underpins a path towards self-awareness, by inviting the subject to consciously reconnect with his internal world and the different sensations that run through it at various moments of daily life. From the perspective of the participants in the study, personal development stimulates a self-therapeutic work whose limits are exceeded by a gradual openness towards another, in a process of therapeutic pre-commitment.</p></div><div><h3>Co","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74412144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Primary psychological care was implemented in Belgium between January and April 2019 as part of the “psy 107” mental health reform. This is part of a wider trend of strengthening primary care at the international level. Belgium, like the Netherlands (Derksen, 2009), Ireland (Corcoran et Byrne, 2017), Australia (37), England (Clark, 2018) and the United States (McDaniel, DeGruy, 2014; McGough et al., 2016), has moved towards a public health model based on a community approach to improve access to psychological care. However, the implementation of psychological treatment in primary care is still relatively recent and has been promoted by the work of clinical researchers who have reported the need to integrate mental health care into their practice (Kaitz et al., 2020). From this perspective, integration can take different forms; in fact, there is no standard model for integrated care but rather several models (Runyan, 2011; Seaton et al., 2021). In line with the “psy107” mental health reform, the federal authorities have implemented first-line psychological care in Belgium for patients aged 18 to 64 with reimbursement from the National Institute for Health and Disability Insurance (RIZIV). For the first time in history, 4 and up to 8 primary psychological sessions per year are reimbursed for mild to moderate symptoms of anxiety, depression or dependence on alcohol or sleeping pills. The implementation of these agreements resulted in the setting up of 20 adult mental health networks delimited on a territorial basis and later the creation of 11 networks dedicated to children and adolescents. In the context of the COVID-19 health crisis, this measure was extended on 2 April 2020 to include patients under 18 years of age and over 64 years of age, as well as the reimbursement of video-consultations. Each session costs the patient 4 or 11.20 euros, depending on whether or not they have an enhanced intervention.
Objectives
The research for this study was commissioned through a public procurement tender and led to the research project “Evaluation of Primary Care Psychology” (EPCAP) conducted by researchers from two universities. The research, which started in February 2020, has four components, focusing respectively on the epidemiological profile of the patients, the place of primary care psychologists and orthopedagogists (PPLs) in the health care network, the economic analysis of this measure, and the development of recommendations for the sustainability of this project. The purpose of this article is to present the profile of psychologists and orthopedagogists, their personal satisfaction, and the implementation of collaborative practices with general practitioners.
Methods
An online survey was distributed via network coordinators to all primary care psychologists and orthopedagogists who are engaged to provide this care in at least one adult network between September 2020 and January 2021. A cen
{"title":"L’implémentation des soins psychologiques de première ligne en Belgique : profil et satisfaction des psychologues et orthopédagogues de première ligne","authors":"Annabelle Kinard , Fabienne Glowacz , Ronny Bruffaerts , Leontien Jansen","doi":"10.1016/j.amp.2023.05.008","DOIUrl":"10.1016/j.amp.2023.05.008","url":null,"abstract":"<div><p>Primary psychological care was implemented in Belgium between January and April 2019 as part of the “psy 107” mental health reform. This is part of a wider trend of strengthening primary care at the international level. Belgium, like the Netherlands (Derksen, 2009), Ireland (Corcoran et Byrne, 2017), Australia (37), England (Clark, 2018) and the United States (McDaniel, DeGruy, 2014; McGough et al., 2016), has moved towards a public health model based on a community approach to improve access to psychological care. However, the implementation of psychological treatment in primary care is still relatively recent and has been promoted by the work of clinical researchers who have reported the need to integrate mental health care into their practice (Kaitz et al., 2020). From this perspective, integration can take different forms; in fact, there is no standard model for integrated care but rather several models (Runyan, 2011; Seaton et al., 2021). In line with the “psy107” mental health reform, the federal authorities have implemented first-line psychological care in Belgium for patients aged 18 to 64 with reimbursement from the National Institute for Health and Disability Insurance (RIZIV). For the first time in history, 4 and up to 8 primary psychological sessions per year are reimbursed for mild to moderate symptoms of anxiety, depression or dependence on alcohol or sleeping pills. The implementation of these agreements resulted in the setting up of 20 adult mental health networks delimited on a territorial basis and later the creation of 11 networks dedicated to children and adolescents. In the context of the COVID-19 health crisis, this measure was extended on 2 April 2020 to include patients under 18 years of age and over 64 years of age, as well as the reimbursement of video-consultations. Each session costs the patient 4 or 11.20 euros, depending on whether or not they have an enhanced intervention.</p></div><div><h3>Objectives</h3><p>The research for this study was commissioned through a public procurement tender and led to the research project “Evaluation of Primary Care Psychology” (EPCAP) conducted by researchers from two universities. The research, which started in February 2020, has four components, focusing respectively on the epidemiological profile of the patients, the place of primary care psychologists and orthopedagogists (PPLs) in the health care network, the economic analysis of this measure, and the development of recommendations for the sustainability of this project. The purpose of this article is to present the profile of psychologists and orthopedagogists, their personal satisfaction, and the implementation of collaborative practices with general practitioners.</p></div><div><h3>Methods</h3><p>An online survey was distributed via network coordinators to all primary care psychologists and orthopedagogists who are engaged to provide this care in at least one adult network between September 2020 and January 2021. A cen","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134995545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.amp.2024.01.015
Suzanne Léveillée , Jean-Pierre Bouchard
This interview between professors Jean-Pierre Bouchard and Suzanne Léveillée focuses on the psychosocial issues of women who have undergone neonaticide. This type of intrafamilial homicide is particularly difficult to understand and the number of cases is almost impossible to determine. These women give birth in secret, and the people around them had not observed their physical change. A psychosocial portrait is drawn up and some elements of understanding are highlighted in this text. The denial of pregnancy, the extreme loneliness of these women and mental health issues allow us to better understand them. Clinical vignettes are developed to identify some elements of these women's life trajectories as well as to set out some avenues for prevention.
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Pub Date : 2024-04-01DOI: 10.1016/j.amp.2024.01.009
Maurice Corcos, Gérard Shadili, Pablo Votadoro, Marion Robin
A society where desolation and delirium reigns attacks first and foremost the human and social sciences, and runs the risk of breaking the bonds of intersubjectivity and solidarity. The renunciation of the latter is at the root of the collective loss of meaning and the return of fear of madness. Mental health caregivers feel the impact of this new world and, seized by the urgency of the situation, act in the present rather than looking to the future, taking history into account, medicalizing and then subjecting human problems of life and death to psychiatric analysis and treatment. The rationalization of diagnostic and therapeutic approaches dictated more by today's economism, which is not a human and social science but an ideology, threatens to sweep away the achievements of institutional child psychiatry, and the indispensable ethic of inter-human encounter that lies at the heart of care.
{"title":"L’avenir d’une illusion humaniste mobilisatrice : le soin psychique","authors":"Maurice Corcos, Gérard Shadili, Pablo Votadoro, Marion Robin","doi":"10.1016/j.amp.2024.01.009","DOIUrl":"10.1016/j.amp.2024.01.009","url":null,"abstract":"<div><p>A society where desolation and delirium reigns attacks first and foremost the human and social sciences, and runs the risk of breaking the bonds of intersubjectivity and solidarity. The renunciation of the latter is at the root of the collective loss of meaning and the return of fear of madness. Mental health caregivers feel the impact of this new world and, seized by the urgency of the situation, act in the present rather than looking to the future, taking history into account, medicalizing and then subjecting human problems of life and death to psychiatric analysis and treatment. The rationalization of diagnostic and therapeutic approaches dictated more by today's economism, which is not a human and social science but an ideology, threatens to sweep away the achievements of institutional child psychiatry, and the indispensable ethic of inter-human encounter that lies at the heart of care.</p></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140467005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
What is psychiatry about? As professionals in the Department of Psychiatry of the Sainte-Anne Army Hospital in Toulon, we decided to formulate an initial three-way discussion between psycho-motor specialists, psychologists and psychiatrists on the subject of psychiatric care, bearing in mind the nuances and even the divergences in our practices. Our current work does not claim to lead to unequivocal thinking; it is based on a desire to support the need for continuity of care, for working together, and for decompartmentalizing the different areas where the subject of psychiatry is relevant, especially in light of the discontinuity that is present in the practice of psychiatry in France today. Our common thread will be transference as a necessary element so that this encounter can develop an unprecedented form of expression.
精神病学是怎么回事？作为土伦圣安娜陆军医院（Sainte-Anne Army Hospital）精神科的专业人员，我们决定就精神科护理这一主题，在精神运动专家、心理学家和精神科医生之间开展一次初步的三方讨论，同时考虑到我们在实践中的细微差别甚至分歧。我们目前的工作并不是要提出明确的观点，而是基于一种愿望，即支持对连续性护理的需要、合作的需要，以及对与精神病学相关的不同领域进行分解的需要，特别是考虑到当今法国精神病学实践中存在的不连续性。我们的共同点是将移情作为一个必要的因素，从而使这种相遇能够发展出一种前所未有的表现形式。
{"title":"Où est le sujet de la psychiatrie ?","authors":"Mégane Héritier (Psychologue clinicienne), Célia Nasonne (Psychomotricienne), Audrey Moulinec (Psychiatre)","doi":"10.1016/j.amp.2024.01.013","DOIUrl":"10.1016/j.amp.2024.01.013","url":null,"abstract":"<div><p>What is psychiatry about? As professionals in the Department of Psychiatry of the Sainte-Anne Army Hospital in Toulon, we decided to formulate an initial three-way discussion between psycho-motor specialists, psychologists and psychiatrists on the subject of psychiatric care, bearing in mind the nuances and even the divergences in our practices. Our current work does not claim to lead to unequivocal thinking; it is based on a desire to support the need for continuity of care, for working together, and for decompartmentalizing the different areas where the subject of psychiatry is relevant, especially in light of the discontinuity that is present in the practice of psychiatry in France today. Our common thread will be transference as a necessary element so that this encounter can develop an unprecedented form of expression.</p></div>","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139812094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1016/j.amp.2023.04.015
Nolwenn Coadic , Dominique Jégaden , David Lucas
Introduction
Several studies have demonstrated the existence of mental disorders and psychosocial risks among sailors, particularly merchant navy officers. The main risk factors reported are assuming the status of an officer, longer working hours and the consequent reduction in sleep time, loneliness, separation from family, and, more recently, the impact of the COVID-19 pandemic (fear for one's own health and that of one's family, and longer embarkation times). The low decision latitude of crew members compared to that of officers has also been highlighted. To date, no studies have been carried out among merchant navy officer cadets.
Methods
A working group including members of the Merchant Navy school and the hospital of the University of Brest was set up. A questionnaire was devised that included demographic and navigational data to which we added the GHQ-12, HAD and Karasek questionnaires. All the students were asked to complete the questionnaire anonymously and submit it electronically. The results of the questionnaires were then analyzed using internationally recognized scoring procedures. A descriptive analysis phase was conducted which was followed by an analysis according to the Karasek scoring categories.
Results
In all, 170 questionnaires were submitted. The participant population was predominantly male (76.4%), and the average age of the students was 21.7 years. Nearly 20% of the students stated that they had experienced a traumatic event during an on-board training course. We note that the average GHQ-12 is 13.3 and therefore higher than 12. The HAD anxiety and HAD depression averages are 6.9 and 5.37 respectively, with 18.2% and 7.6% of the students included showing signs of anxiety and depression. According to Karasek's classification, we note that the “active” class is the most represented with 29.4% of students, followed by the “tense” and “relaxed” classes with 27.6%. The “passive” class is the least represented with 15.3%.
Discussion
This study demonstrates that the students of the French Merchant Navy Officer Training School evaluated their overall health as average, with a predominance of anxiety disorders but few signs of depression. Signs of “work strain” according to the Karasek questionnaire were found in 1/4 of these young officers. The proportion of cadets showing signs of anxiety and depression according to the HAD questionnaire is similar to that shown in studies among French and European officers. On the other hand, the proportion of cadets classified as “tense” is higher. Concerning traumatic events, in a semi-structured analysis of the students’ first deployments at sea, the main stress factors reported were how the ship was managed, damaged, piracy and then weather conditions. The period of study within the ENSM involves both a period of theoretical learning but also one of practical training. In the highly specific environm
{"title":"Évaluation de la santé mentale et des facteurs psychosociaux chez les élèves officiers de l’école de la marine marchande","authors":"Nolwenn Coadic , Dominique Jégaden , David Lucas","doi":"10.1016/j.amp.2023.04.015","DOIUrl":"10.1016/j.amp.2023.04.015","url":null,"abstract":"<div><h3>Introduction</h3><p>Several studies have demonstrated the existence of mental disorders and psychosocial risks among sailors, particularly merchant navy officers. The main risk factors reported are assuming the status of an officer, longer working hours and the consequent reduction in sleep time, loneliness, separation from family, and, more recently, the impact of the COVID-19 pandemic (fear for one's own health and that of one's family, and longer embarkation times). The low decision latitude of crew members compared to that of officers has also been highlighted. To date, no studies have been carried out among merchant navy officer cadets.</p></div><div><h3>Methods</h3><p>A working group including members of the Merchant Navy school and the hospital of the University of Brest was set up. A questionnaire was devised that included demographic and navigational data to which we added the GHQ-12, HAD and Karasek questionnaires. All the students were asked to complete the questionnaire anonymously and submit it electronically. The results of the questionnaires were then analyzed using internationally recognized scoring procedures. A descriptive analysis phase was conducted which was followed by an analysis according to the Karasek scoring categories.</p></div><div><h3>Results</h3><p>In all, 170 questionnaires were submitted. The participant population was predominantly male (76.4%), and the average age of the students was 21.7 years. Nearly 20% of the students stated that they had experienced a traumatic event during an on-board training course. We note that the average GHQ-12 is 13.3 and therefore higher than 12. The HAD anxiety and HAD depression averages are 6.9 and 5.37 respectively, with 18.2% and 7.6% of the students included showing signs of anxiety and depression. According to Karasek's classification, we note that the “active” class is the most represented with 29.4% of students, followed by the “tense” and “relaxed” classes with 27.6%. The “passive” class is the least represented with 15.3%.</p></div><div><h3>Discussion</h3><p>This study demonstrates that the students of the French Merchant Navy Officer Training School evaluated their overall health as average, with a predominance of anxiety disorders but few signs of depression. Signs of “work strain” according to the Karasek questionnaire were found in 1/4 of these young officers. The proportion of cadets showing signs of anxiety and depression according to the HAD questionnaire is similar to that shown in studies among French and European officers. On the other hand, the proportion of cadets classified as “tense” is higher. Concerning traumatic events, in a semi-structured analysis of the students’ first deployments at sea, the main stress factors reported were how the ship was managed, damaged, piracy and then weather conditions. The period of study within the ENSM involves both a period of theoretical learning but also one of practical training. In the highly specific environm","PeriodicalId":7992,"journal":{"name":"Annales medico-psychologiques","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89021619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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