Encephale
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Behçet's disease is a multisystem vasculitis of unknown origin. The prevalence of the disease varies widely and is high in the Eastern Mediterranean Basin, North Africa, Iran and Japan. Many clinical features of Behçet's disease have been described and the international study group for Behçet's disease has defined a set of diagnostic criteria. These require the presence of recurrent oral ulcers plus two of the following: recurrent genital ulcerations, typical defined eye lesions, typical defined skin lesions or a positive pathergy test (a skin hypersensitivity reaction to a non-specific physical insult; when positive, the response consists of a papule or pustule that develops after 24 to 48 hours at the site of a needle prick to the skin). Although not included in these diagnostic criteria, there are some other features commonly seen in patients with Behçet's disease: thrombophlebitis, oligo-arthritis, gastrointestinal ulcerations and neurological involvement. Neuro-Behçet is well described in Behçet's disease, with variable prevalence rates between 5.3 and 35%. This prevalence is probably affected by the type of study (retrospective or prospective) and regional and ethnic variations in disease expression. Psychiatric symptoms usually occur as incidental findings in some patients with neurological disease; they are misdiagnosed and mistreated. ⋯ Retrospective analysis of this patient's course suggests that -psychiatric episodes were always associated with physical manifestations. However, pleurisies, lymphangitis, uterine and rectal tumours have never been described in Behçet's disease. This vasculitis occurs less frequently in the Caribbean than in Mediterranean, Middle East or Japan. It seemed that this patient had a psychotic syndrome and a chronic relapsing multisystem disorder, more complex than Behçet's disease. A prospective study would be useful to characterize psychiatric patterns of Behçet's disease and establish their relationships with physical manifestations, especially neurological involvement.
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One of the problems of consultation-liaison psychiatry is the absence of request of the patient. Indeed, the patients do not recognize their disorder and prefer to go to the emergency unit in a general hospital. Thus, we meet in the emergency unit or in medical unit (liaison psychiatry activity). ⋯ Our systemic vision of the consultation-liaison psychiatry proposes a pragmatic collaboration, centred on the problem. This approach allows the patient to prepare to meet the psychiatrist, and does not a priori discredit the intervention. Presented by the staff, who know the problem in concrete terms and are ready to answer it in a concrete way, this mode of intervention is only the first step of subsequent psychiatric care.
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In this review, we conclude that cognitive impairments are as important as positive and negative symptoms in the clinical assessment and management of patients with schizophrenia. This is not a comprehensive review, considering that the new Measurement And Treatment Research to Improve Cognition in Schizophrenia (MATRICS) model will soon provide valuable data. It is however a product of the collective efforts of a French Canadian clinical research team that proposes a synthesis of data of pragmatic interest to clinicians. Medication with improved safety and cognition profile, gene-rally lead to better outcomes by facilitating compliance with drug regimens and rehabilitation programs. In addition, measures of attention and executive function (EF) appear to improve with novel antipsychotics when compared to traditional neuroleptics. Nevertheless, evaluating cognitive performance is not a routine procedure outside the domain of research. For example, procedural learning (PL) -- an important measure of cognitive function -- refers to cognitive and motor learning processes in which execution strategies cannot be explicitly described (ie learning by doing). These actions or procedures are then progressively learned through trial and error until automation of optimal performance is established. Procedural learning is rarely assessed in clinical practice. Inconsistent findings regarding the effects of neuroleptic drugs on PL have been reported. ⋯ This review concludes that from now on cognitive deficit should be recognized as a major element in social and professional integration of schizophrenia patients, and should become a standardized assessment approach in clinical practice.
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Work, for many years reduced to a purely instrumental dimension, proves to be a true microcosm of society, with its informal modes, its emotional networks and its series of evils and dilemmas. This human apprehension of the professional sphere tends to reveal a pole with multiple facets, some of which have long been concealed, but whose individual, social and economic extent can't let people ignore them. This social perception, which contributes to regard work as sacred and makes it impervious to any aggression, should be abandoned. Bearing this in mind, our study endeavours to show that "work" and "victim" are far more overlapping than antagonistic realities; it aims at determining the impact of two aggressive methods via the professional pole, namely: moral harassment at work and armed attacks within bank premises. Such an approach tends to unify health psychology, occupational psychology and victimology, thus opening a breach in the stereotyped view which crystallizes the professional sphere into a kind of representative noose devoid of the most human bases. We then suggest, as a first hypothesis, that the nature of the victimization process, resulting from specific aggressive scenarios, would determine different psychological, physiological and relational consequences, apprehended under the generic expression of tolerance threshold. In other words, "mobbing", through its proactive, intentional and obsessional dimension would tend to lower the victims' threshold more than hold-ups, which are characterized by a reactive aspect, and obey unfavourable socio-economic contingencies. Our research also aims at apprehending this dynamic relationship binding victimization types to tolerance thresholds through two analysing factors. These psychological mediators are derived from Lazarus and Folkman's "transactional model of stress", which postulates that stress would rise from the perception people get of the transaction between the requirements of the situation and their own resources. These modulators would correspond to the social evaluation of the stressor and the adjustment strategies adopted by the victims. We then postulate the fact that these interfering variables would determine a connection between the type of victimization and the series of signs and symptoms generated. In other words, the aversive modes would refer to a process of significance via these interpolated socio-cognitive factors, thus forming a trace of the traumatic event according to the tolerance threshold expressed. More precisely, our assumption consists in postulating that the insidious and latent aspect of harassment which is supposed to support a dispositional attribution of the harasser's intrigues as well as the preferential adoption of coping strategies centred on emotional control, would lower the victims' tolerance threshold further, than a visible and instantaneous hold-up which is supposed to condition an essentially situational perception and the adoption of strategies mainly directed towards the problem. ⋯ Considering these first results, which call for further study, our impression is that it seems to be relevant to consider the setting-up of psychological therapy programs adapted to the very nature of each victimization case.