Annales medico-psychologiques最新文献

Background

Telemedicine and virtual psychotherapy have been developing worldwide for over a decade, but evaluations of this new treatment modality are still too rare. Is this evolution in therapeutic treatment protocols satisfactory? Does resistance to this development come from the practitioner or the patient? Can long-term COVID, a chronic pathology that emerged after the pandemic of 2020, benefit from this approach to therapy? This article seeks to answer that question.

Objectives and methods

Structured in two parts, this article first presents a detailed review of past and current work on telemedicine, and virtual psychotherapy. In the second part, the authors explore ways of treating the psychopathological symptomatology of long COVID, which is essentially characterized by anxiety-depressive disorders as well as post-traumatic stress disorder (PTSD).

Results

Multidisciplinarity is essential in the management of long COVID. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) have proved to be effective treatment methods for the psychopathological disorders inherent in long COVID. Virtual reality, as well as augmented reality, also seems to be indicated as effective in virtual psychotherapy treatment of post-traumatic stress disorder (PTSD).

Discussion and conclusion

Whatever the theoretical model underlying the actions and methods of virtual psychotherapy, it is important to accept without hesitation the framework. It would appear that the transferential and counter-transferential components of therapeutic relationships are not affected by the change of setting. The quality of the therapeutic alliance is strengthened by the reassuring aspect of consultations from the patient's usual place of residence. In addition to videoconference therapies, epistolary therapies using email exchanges seem also to be particularly interesting.

Aims

The aim of our study is to explore the mechanisms that come into play in cases of suicidal acts during the post-partum period. Our starting point is to emphasize the importance of multidisciplinary support – psychological, medical and social – in establishing a multifaceted network for parents during and after pregnancy. Additionally, the link between post-partum depression and suicidal behavior is discussed, as are the different types of risk factors.

Method

Our method consists of a review of the literature on the issues involved in supporting women in the ante- and post-partum periods, to prevent or support post-partum depression, and any resulting acts of aggression. These observations are then supported through the study of a clinical case illustrating the blind spots in the care system, which can leave certain subjects out in the cold. The clinical case illustrates the desire to have a child, the use of drugs during the perinatal period and the consequences of confinement in France during the post-partum period.

Results

The results of our study show that the post-partum suicidal trajectory is multifactorial, originating in the antepartum period, combining endogenous and exogenous factors, as well as society's supposed expectations of the mother-to-be. It should also be noted that support for mothers suffering from post-partum depression is often uneven in the different regions of the country, due to a lack of resources in terms of staff or structure, sometimes allowing the patient to slip through the net of care, leading her to act out. Information and training for professionals on the issue of the post-partum period and its possible repercussions on the mother's behavior are essential for better prevention and rapid treatment. Sometimes, depression is diagnosed during pregnancy, which facilitates treatment and speeds up contact with professionals to provide the best possible support for the mother during her perinatal period.

Conclusion

We note, however, that multidisciplinary support for suicidal women helps limit the risk of the symptoms worsening and the risk of the patient acting on them. We emphasize and encourage concerted work and cooperation between institutional professionals and independent professionals in the psychiatric, medical, and social fields, to establish the multidisciplinary network needed to support all women, as they become mothers. Multidisciplinary support for mothers is essential during the perinatal period. Of course, we need to consider the importance of the health professional's work, but the family, spouse, and friends are also essential resources for the mother's well-being, and it is important to include them in this support network.

Context

After a period of low-key development, phenomenology is once again gaining ground in psychiatry, as well as in clinical psychology and psychopathology. It is becoming particularly relevant in these fields, where the observation of phenomena and the quest for structures to organize them are very appropriate clinical tools for understanding the subject.

Objectives

The aims of this article are, on the one hand, to review the development of structural phenomenology in the human and medical sciences, and on the other hand, to explore its relationship to creative processes in order to support pragmatic reflection on patient care.

Method

This study is based on the clinical case of a 14-year-old adolescent with Williams & Beuren syndrome. After six years of institutional care, he participated in a program of eight sessions of art therapy designed to retrace his pathway for access to pre-professionalization. Our evaluation is based on a test/retest evaluative clinic using the Rorschach projective test and the Content Analysis Grids centered on the Phenomeno-structural Approach (GACAPS) developed by L. Schiltz.

Results

We noted an improvement in the adolescent's attention and social skills, as well as an increase in his ability to mobilize his imagination and to access the elaboration of his thoughts. However, the phenomeno-structural analysis, aside from the increasing number of creative responses, enabled us to detect invasive anxieties, which make us fear that, with him, this existential stage of a rite of passage represents a risk that could lead to psychotic problems.

Discussion

Phenomenology, given that it is a subtle method, only makes sense if practiced in the world of real life, where “being in the same landscape” becomes as much a diagnostic tool as it is a treatment process. The Rorschach Test with its GACAPS analysis grids, as well as the IPSE method (Processus inductif d’analyse de la structure de l’expérience vécue - Inductive Process for the Analysis of the Structure of Lived Experience), are pragmatic tools providing relevant results in a context of a clinic of modernity.

This article aims to explore the creative processes in the pictorial work of Jean-Michel Basquiat (1960–1988). Considered as one of the greatest modern artists, Basquiat's partly tragic trajectory raises questions about his capacity for sublimation of not only Eros but also Thanatos drives. Based on interviews, testimonies, and writings, our method consists first in analyzing Basquiat's biography which, through his subjective experience, questions the difference between creativity and creation. Our results show how a triple trauma Basquiat suffered in his childhood fueled his sublimatory dynamics. These traumatizing events – the death of his older brother, his own near fatal accident, and his mother's mental illness – induced Basquiat to create new solutions in his outstanding art to unite creative and destructive impulses. An in-depth analysis of his pictorial style provides strong evidence for this assumption. In conclusion, we discuss the relevance of psychoanalysis in exploring the lesson that artists and their creative processes can teach us. How do their participation in their unconscious, their personal history, and trauma support or hinder their process of sublimation?

Introduction

Previous studies have found brain abnormalities and deficits in cognitive functions in people with fibromyalgia. It is known that choreography or creative tasks significantly generate cognitive improvements. Various methods have been described in the literature to evaluate creative activities using electroencephalography (EEG), such as the imagination of dance improvisations. However, there is the notion that creative solutions can emerge during the action and that creative motor action may reflect new, statistically rare, and adaptive coordination and/or the control solutions performed.

Aim

This study seeks to establish an operational approach to test how constraints are combined to induce variability of movement and how to evaluate it, but without forgetting the ideation or preparation of the activity as a relevant section in the study of motor creativity. To this end, this study aims to validate and test the reliability and applicability of an innovative test of motor creativity: The Motor Creativity Assessment (MCA), with the aim of achieving an objective score of motor creativity that can be used to test patients and monitor the interventions.

Material and methods

to correctly satisfy the requirements of the standard protocol for clinical trials, this study has followed the SPIRIT 2013 Statement Items. A total of 13 women with fibromyalgia and 13 healthy women were included in the study. The individual's cognitive impairment, sleep quality, pain, quality of life, level of physical activity, fear of falling, and the impact of fibromyalgia will be studied. This study develops a specific test of motor creativity without the use of objects, with the aim of achieving an objective score of motor creativity. An observation score sheet allows motor creativity to be analyzed and scored by viewing a video of the creative movement test. The Enobio® instrument (Neuroelectrics, Cambridge, MA, USA) and Neuroelectrics® instrument driver software (NIC1) were used to record EEG and heart rate variability signals.

Cognitive Evoked Potentials (PEC) are endogenous potentials of non-invasive and ancient realization. It is a complementary practice that is not common in the psychiatric field. The description of the PECs carried out in the Limoges psychiatric hospital center is made around 2 groups of psychiatric pathologies: psychotic disorders, depressive disorders. The analysis of the different components of the PEC allows to better define the clinical characteristics in the patients. P300 and contingent negative variation (CNV) potentials describe clinical indicators such as psychomotor retardation, cognitive difficulties, anticipation, attention, memory and task integration. The P50 allows you to see the ability or not for a patient to filter sensory information. The combination of four tests (P300 in direct averaging, P300 in backward averaging, CNV and P50) provides additional detailed information, especially since associated pathologies are frequent in the same patient. The treatment of patients often presents several associated molecules. The aim of this work is to take stock of this additional assessment of psychiatric disorders in a neurophysiology unit.

Psychological autopsy has been added to the psychiatrist's diagnostic toolbox since his creation in the United States in the late 1950s. However, we wonder about the scientific validity of this method. Therefore, we trace the history of its creation, before pointing out the methodological flaws and defects: we maintain that 1) it is impossible to diagnose a mental disorder in a deceased person by interviewing relatives and acquaintances, 2) that the scientific literature supporting the validity of the method does not demonstrate that it is possible to respond scientifically to point 1 and 3) that the association between depression and suicide is an artifact introduced by the methodological flaws of the studies on psychological autopsy. We finally show that its use today exceeds the objective of its creators.

Introduction

Collusion designates a specific type of transference-countertransference interaction between two or more persons, linked by an unconscious and shared unresolved issue, which they avoid on an intrapsychic level by externalizing it in the interpersonal space.

Objective

To find a way to identify collusion and to delineate it from other transference-countertransference interactions. We conducted this study based on a case series approach.

Methods

The study material consisted of audiotaped clinicians-centered supervisions with oncologists. The case series methodology involved the systematic examination of a purposive sample of supervisions, with the aim to understand how and why they differ from one another with respect to the relational dynamic between the physician and his/her patient.

Results

Four cases/supervisions were selected as they allowed to situate collusion on the spectrum of transference-countertransference interactions. We report on it by describing a countertransference reaction, two transference-countertransference interactions, and a collusion.

Conclusions

The study reveals the challenges and pitfalls of research on collusion. The results allow to confirm the criteria of our working definition of collusion and to delineate collusion from other transference-countertransference interactions, which represents a first step for the empirical investigation of collusion.