Pub Date : 2024-04-01DOI: 10.1016/j.amp.2023.04.012
Nicolas Zdanowicz, Carole Jassogne
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.
{"title":"Le temps de la psychothérapie des psychotiques est-il révolu ?","authors":"Nicolas Zdanowicz, Carole Jassogne","doi":"10.1016/j.amp.2023.04.012","DOIUrl":"10.1016/j.amp.2023.04.012","url":null,"abstract":"<div><h3>Objectives</h3><p>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?</p></div><div><h3>Material and methods</h3><p>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.</p></div><div><h3>Results</h3><p>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”.</p></div><div><h3>Conclusion</h3><p>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.</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":"80580284","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.2023.12.001
Vivianne Kovess-Masfety , Lucia Romo , Anne Dezetter
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
{"title":"La longue marche du remboursement des psychothérapies par l’assurance maladie en France","authors":"Vivianne Kovess-Masfety , Lucia Romo , Anne Dezetter","doi":"10.1016/j.amp.2023.12.001","DOIUrl":"10.1016/j.amp.2023.12.001","url":null,"abstract":"<div><h3>Objectives</h3><p>To outline the procedure for obtaining reimbursement by the French National Health system for psychotherapy provided by private practitioners.</p></div><div><h3>Method</h3><p>By conducting a review of scientific literature, reports, plans, and governmental decisions.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Discussion</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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 ","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":"139192707","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.2023.09.013
Patricia Kirkove , Pierre Oswald
There is considerable confusion between the terms multidisciplinarity, interdisciplinarity and transdisciplinarity. Multidisciplinarity suggests a juxtaposition of knowledge. The various specialists in their disciplines complement each other and intervene alongside each other around a common subject. This produces points of view, which are superimposed, without bringing out any real added value. Interdisciplinarity requires interaction and interrelation. The pooling of knowledge requires a greater intertwining of disciplines, minimizing the differences between them while preserving their specificities and their foundations. A specialist's robust monodisciplinary expertise enriches the other members of the team, allowing for a more global, more systemic approach. Refusing to approach complex problems through the categorial prism of individual disciplines, transdisciplinarity seeks to integrate disciplines to go between, through and beyond disciplines by completely dissolving traditional boundaries. One of the particularities of complex holistic care, such as that in psychiatry, is that it cannot be managed effectively by a single person or a single discipline. Hyperspecialization results in a segmentation of the human being by no longer taking into account the entirety of the person treated. By analyzing and harmonizing the links between the different disciplines, interdisciplinarity sheds light on complex situations and enriches the responses offered. It improves quality, offers a global approach to the patient by mobilizing knowledge from different disciplines and by defragmenting and decompartmentalizing their knowledge. Interdisciplinarity is not self-evident and it cannot be likened to a simple mode of coordination where complementarity is valued. To meet this challenge, communication, coordination and clarification of roles by the team leader, whose leadership is recognized and valued, are essential. The medical literature recognizes a real added value of interdisciplinary approaches in complex medical situations. Eventually, it may be necessary to go a step further. Nevertheless, transdisciplinarity is of such complexity and requires such maturity of the teams, that we do not support it as the first step toward implementing a patient holistic approach. By way of conclusion, we propose the metaphors that Choi and Pak developed. Multidisciplinarity is in a way a mathematical equation of the “2 + 2 = 4” type or, more daringly, a “salad bowl”, juxtaposition and addition of ingredients or skills. Interdisciplinarity is likened to an equation of the “2 + 2 = 5” type or a “melting pot”, which postulates that the result, due to an effective and harmonious interaction, is greater than the sum of the parts. Finally, they compare transdisciplinarity using a “2 + 2 = yellow” equation with the culinary metaphor of the “cake” hi
{"title":"L’interdisciplinarité pour des soins holistiques en hôpital psychiatrique : pourquoi et comment relever ce défi ?","authors":"Patricia Kirkove , Pierre Oswald","doi":"10.1016/j.amp.2023.09.013","DOIUrl":"10.1016/j.amp.2023.09.013","url":null,"abstract":"<div><p>There is considerable confusion between the terms multidisciplinarity, interdisciplinarity and transdisciplinarity. Multidisciplinarity suggests a juxtaposition of knowledge. The various specialists in their disciplines complement each other and intervene alongside each other around a common subject. This produces points of view, which are superimposed, without bringing out any real added value. Interdisciplinarity requires interaction and interrelation. The pooling of knowledge requires a greater intertwining of disciplines, minimizing the differences between them while preserving their specificities and their foundations. A specialist's robust monodisciplinary expertise enriches the other members of the team, allowing for a more global, more systemic approach. Refusing to approach complex problems through the categorial prism of individual disciplines, transdisciplinarity seeks to integrate disciplines to go between, through and beyond disciplines by completely dissolving traditional boundaries. One of the particularities of complex holistic care, such as that in psychiatry, is that it cannot be managed effectively by a single person or a single discipline. Hyperspecialization results in a segmentation of the human being by no longer taking into account the entirety of the person treated. By analyzing and harmonizing the links between the different disciplines, interdisciplinarity sheds light on complex situations and enriches the responses offered. It improves quality, offers a global approach to the patient by mobilizing knowledge from different disciplines and by defragmenting and decompartmentalizing their knowledge. Interdisciplinarity is not self-evident and it cannot be likened to a simple mode of coordination where complementarity is valued. To meet this challenge, communication, coordination and clarification of roles by the team leader, whose leadership is recognized and valued, are essential. The medical literature recognizes a real added value of interdisciplinary approaches in complex medical situations. Eventually, it may be necessary to go a step further. Nevertheless, transdisciplinarity is of such complexity and requires such maturity of the teams, that we do not support it as the first step toward implementing a patient holistic approach. By way of conclusion, we propose the metaphors that Choi and Pak developed. Multidisciplinarity is in a way a mathematical equation of the “2<!--> <!-->+<!--> <!-->2<!--> <!-->=<!--> <!-->4” type or, more daringly, a “salad bowl”, juxtaposition and addition of ingredients or skills. Interdisciplinarity is likened to an equation of the “2<!--> <!-->+<!--> <!-->2<!--> <!-->=<!--> <!-->5” type or a “melting pot”, which postulates that the result, due to an effective and harmonious interaction, is greater than the sum of the parts. Finally, they compare transdisciplinarity using a “2<!--> <!-->+<!--> <!-->2<!--> <!-->=<!--> <!-->yellow” equation with the culinary metaphor of the “cake” hi","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":"139192522","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.2024.01.014
Charles Gheorghiev
{"title":"Le soin psychique. Entre l’impasse de son actualité et les enjeux de son avenir, une tentative de définitions","authors":"Charles Gheorghiev","doi":"10.1016/j.amp.2024.01.014","DOIUrl":"10.1016/j.amp.2024.01.014","url":null,"abstract":"","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":"139816573","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.2024.01.010
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
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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.
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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}
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