Promoting healthy lives and well-being for all: The contribution of the International College of Person-Centered Medicine (ICPCM)

This article defines the scope of Person-Centered Medicine, traces its roots in ancient conceptions, explains the reasons for the revival of this perspective in our times, and highlights the contribution of the International College of Person-Centered Medicine (ICPCM) in the promotion of the personcentered perspective in health and disease. The value of communication is underlined with reference to both diagnosis and treatment. The concept of Health is considered historically and the inclusiveness, holistic vista and positive health orientation of the WHO definition of Health (1948) is underlined. It is emphasized that Mental Health Promotion is differentiated conceptually from Disease Prevention in that promotion deals with health and prevention deals with illness, the relationship of Health Promotion with Salutogenesis (Antonovsky 1996) is noted and it is pointed out that among the targets of health promotion, preservation of peace is also included (WHO, 2004). In line with this, the ICPCM has supported and co-signed the Athens Anti-War Declaration (2016). Evaluating the impact of Health Promotion efforts is a necessary but difficult task as it requires targeted research and there are many inherent confounding factors. The social or environmental contexts of health behaviors should be taken into account as well as the subjective indicators of health. In an attempt to resolve the difficulties arising from this issue, the ICPCM has developed a prototype "Person-centered Care Index" (Kirisci et al 2016). With reference to Education it is pointed out that it is necessary for the educators to speak with the students rather than speak to them. Concerning research, the ICPCM in its 2013 Geneva Declaration has identified the main research areas in the person-centered field. The importance of assuring healthy lives and well-being for ALL is underlined and the difficulties associated with the achievement of this goal are noted. Lastly, the need to apply the principles of Person-centered Medicine to victims of natural, human-made and economic disasters (Christodoulou et al 2016) is underlined, especially in view of the frequent occurrence of these disasters in our times. In conclusion, the contribution of the ICPCM during the ten years of its existence, with reference to the sensitization of health professionals in the Person-centered approach is noted. This contribution has been carried out in line with the principles of the ICPCM and with its Geneva Declarations.

Reframing autism as a behavioral syndrome and not a specific mental disorder: Implications of genetic and phenotypic heterogeneity

Clinical and molecular genetics have advanced current knowledge on genetic disorders associated with autism. A review of diverse genetic disorders associated with autism is presented and for the first time discussed extensively with regard to possible common underlying mechanisms leading to a similar cognitive-behavioral phenotype of autism. The possible role of interactions between genetic and environmental factors, including epigenetic mechanisms, is in particular examined. Finally, the pertinence of distinguishing non-syndromic autism (isolated autism) from syndromic autism (autism associated with genetic disorders) will be reconsidered. Given the high genetic and etiological heterogeneity of autism, autism can be viewed as a behavioral syndrome related to known genetic disorders (syndromic autism) or currently unknown disorders (apparent non-syndromic autism), rather than a specific categorical mental disorder. It highlights the need to study autism phenotype and developmental trajectory through a multidimensional, non-categorical approach with multivariate analyses within autism spectrum disorder but also across mental disorders, and to conduct systematically clinical genetic examination searching for genetic disorders in all individuals (children but also adults) with autism.

Occupational identity crisis of professionals dealing with difficult adolescents

This study tests the hypothesis of vulnerability in health and social care professionals dealing with difficult adolescents. This vulnerability appears to be underpinned by an occupational identity crisis that seems to diminish the ability of these professionals to recognize the suffering of these adolescents. A questionnaire was developed and then distributed during a network day bringing together members of various institutions and bodies working with difficult adolescents. Ninety-three professionals responded. Occupational identity weaknesses were identified: inadequate basic training, experiences of solitude, feelings of powerlessness and exposure, inadequate personal and institutional resources. Actors involved express their need for inter-institutional and inter-sectoral network but find it uneasy to implement. Some changes can be recommended to reduce this occupational identity crisis: increased efforts towards continuing training, development of possibilities of reflection within institutions, and more structured partnerships and actions.

AFP – Le désir mimétique : entre psychopathologie et neurosciences

Nous nous interrogerons à travers des approches différentes au désir mimétique en relation avec les travaux de René Girard. Celui-ci a développé le concept de désir mimétique, interférence immédiate du désir imitateur et du désir imité. En d’autres termes, ce que le désir imite est le désir de l’autre, le désir lui-même. Cette théorie nous questionne sur l’objet, le mouvement du désir, la relation à l’autre et au-delà sur son implication dans le soin. Nous revisiterons ainsi les concepts psychopathologiques, sans manquer d’évoquer les travaux neuroscientifiques sur les neurones miroirs qui ont permis à des chercheurs de faire un lien entre ces neurones et le mécanisme de l’empathie, données pouvant conférer une assise à la théorie mimétique.

AFP – De l’oubli à la mémoire : la construction du souvenir

Le rôle de l’oubli dans l’équilibre instable de la vie psychique et dans la construction des souvenirs individuels et collectifs apparaît essentiel. Le travail clinique s’organise tout autant sur les réminiscences qui font souffrir, le temps figé des traumatismes que sur l’amnésie. La question qui se pose alors d’un point de vue aussi bien neuroscientifique, psychanalytique que philosophique est de l’oubli nécessaire pour exister.

Child is father of the man: child abuse and development of future psychopathology

Available epidemiological data indicate that the abuse of children within families is a very common phenomenon, and is still on the rise. Among others, abuse includes direct physical and emotional violence to the child, as well as the indirect emotional trauma of witnessing interparental violence. These early trauma experienced within the context of the family can influence the development of the child's personality as well as predispose towards the development of mental disorders in adulthood. There are some important factors influencing the occurrence of abuse, or the conditions predisposing it: certain parental personality traits appear to be instrumental, and the presence of individual psychopathology of parents is also connected with different forms of family dysfunction as a system, representing a variable which is interpolated in the quality of parenthood as the most important factor that determines long-term consequences on children and possible future psychopathology. The complex but tangible effects of parents' personality traits on the psychological development of children may contribute to the transgenerational transmission of abuse and violence. The phenomenon of domestic violence and abuse can be described from the perspective of the psychological and systemic theoretical postulates. According to systemic theory and practice, dysfunctional communication in the family is a significant predictor for domestic violence. Characteristics of dysfunctional communication include low levels of verbal expressiveness and emotional responsiveness, low tolerance to criticism and its interpretation as a threat or intimidation, and consequently increased anxiety and subsequent escalation of an argument into violence. Overall it seems that there may be a complex connection between parental personality and family interaction patterns, leading to dysfunctional communication which further amplifies the detrimental characteristics of family dynamics, and eventually escalates to violence. According to one theory, there may be a degree of transgenerational transmission of these communication patterns in children who have been victims of violence, thus propagating the conditions for violence, this time perpetrated by the victims themselves. Therefore there is a pressing need for prevention, perhaps through psychoeducation for parents or through early detection and treatment of traumatized children and adolescents, in the hope that the transgenerational vicious cycle of violence may be broken.

Soins sous contrainte en psychiatrie de l’enfant et de l’adolescent

L’immaturité de l’enfant et son étroite dépendance au contexte éducatif et affectif dans lequel il vit ont d’importantes conséquences sur les modalités de ses soins. D’abord parce que dans les situations ordinaires, celles qui sont heureusement les plus fréquentes, demander ou consentir à ces soins est une des prérogatives des dépositaires de l’autorité parentale, c’est-à-dire généralement les parents. Ensuite parce que c’est aux représentants de l’état et à la justice qu’il revient de suppléer aux parents lorsque ceux-ci sont défaillants ou qu’ils sont, pour une raison ou une autre, empêchés de remplir les devoirs que cette autorité leur confère, dans l’intérêt de l’enfant. La place des conseils généraux et de la justice des mineurs dans les dispositifs de protection de l’enfant en est une illustration éclatante, comme le sont également les modalités particulières qui, depuis déjà longtemps, judiciarisent les soins psychiatriques sous contraintes chez les enfants et les adolescents. Lors de cette présentation nous insisterons tout particulièrement sur ce dernier aspect en évoquant notamment l’Ordonnance de placement provisoire en psychiatrie ainsi que les questions complexes que pose l’obligation de soin si fréquemment utilisée dans l’articulation entre santé et justice en pédopsychiatrie.

Cultural Mediations in the Therapeutic Process with Border Lines Adolescents

Psychopathology of bounding is a central feature in Border Line Adolescents. This feature is underlying both their violent acting and their reluctance to engage in a therapeutic relation. In a milieu treatment, cultural mediations appear as one of the best way to overcome this difficulty because they put the focus on pleasurable activities rather than on the relation itself. It allows the therapeutic staff to find a way out of the paradox where relation which is the main therapeutic solution is at the same time the main psychopathological problem.

French classification for child and adolescent mental disorders

This report presents the French Classification of Child and Adolescent Mental Disorders (CFTMEA), operational since 1983 and validated through a broad multicentric study. CFTMEA is now the classification of reference for French child psychiatrists, who appear to be comfortable with it because it fits their diagnostic and therapeutic work. It bases its clinical categories on a psychopathological approach which includes an appraisal of potentials and prognosis. CFTMEA is deliberately built on two quite distinct axes: Axis I: basic clinical categories, and Axis II: associated and possibly etiological factors. The CFTMEA favors a broad appraisal of the disorders that it classifies, seeking whenever possible to establish a structural diagnosis based on psychodynamic psychopathology. The CFTMEA does not claim to be atheoretical, but does not impose a theoretical allegiance, because it is compatible with any etiological concepts. The CFTMEA's last revision (R 2000) is in an advanced phase of validation.

[Borderline syndrome in adolescence. Discussion apropos of a clinical case]

The "border-line" syndrome in adolescence is typified, not only by a suggestive symptomatology, but above all by a stable and specific abnormal structure of the ego originating in a developmental arrest. This syndrome is discussed with reference to the clinical case reported here. Although, from a purely semeiological point of view, this adolescent had an acute psychotic episode, this condition was related to a transformation of the ego in which the separation-individualization process was involved. The treatment which was initiated is based on this psychopathological explanation.