Encephale
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Stress cardiopathy, also called "Tako Tsubo" is a cardiac pathology linked to an acute coronary syndrome with electrocardiographic signs and an increase in the level of cardiac enzymes, without any abnormality on coronarography. This syndrome is secondary to great physical or mental stress. Mortality and the risk of recurrence are low. However, there is no consensus for treatment or prevention. ⋯ We know that people with a stressing job have probably more chance to suffer a myocardial infarction (the risks are 1.5 or two times greater for them). The prevalence of cardiomyopathy syndrome is 4.9% for women. These women have gone through the menopause, with a history of hypertension and anxiodepressive symptoms. However, we do not find any similar description (behavioural scheme type A) as is shown by the psychosomatic school in cases of patients who have gone through myocardial infarction. We also can question ourselves about the fact that some people can be predisposed to suffer from "Tako Tsubo" cardiomyopathy and about the existence of personality disorders. What then is the role of the psychiatrist with these patients?
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Prison is typically considered as a dangerous setting partly because of promiscuity and violence, which leads to a whole series of suffering and frustration among prisoners. Due to their occupation, prison guards must ensure the safety of the inmates, their colleagues, as well as any other persons working in prison and in the prison setting. Thus, correctional guards are the "Bumper excitement" of prison violence and suffer from stressful and traumatic events. Indeed, inmates' sufferings and frustration are firstly expressed towards them because they share daily relationships with inmates. In addition, correctional guards are faced with the high inmate suicide risk. One potential consequence of these chronic stressful situations is burnout. Burnout is described as a three-dimensional syndrome composed of emotional exhaustion, depersonalization and sense of lack of personal accomplishment. Burnout is a severe psychological suffering, which can lead to depression. It has been initially identified among persons who are working with patients. Nevertheless, research shows that burnout is not a psychopathology of work but of the relationship with others. In other terms, burnout seems to arise when people share stressful, chronic and violent relationships with someone else. Burnout doesn't appear per se in any international classification of mental disorders: clinicians often use the diagnosis of adjustment disorder. ⋯ The results indicate that demographic variables such as age, sex or level of studies have no significant effect on GB, EE, D and PA levels. Tenure has a significant effect on GB and D levels. Concerning correctional variables, results show that the penal status of prison has a significant effect on GB and EE. Prison guards working with inmates incarcerated for more than 5years report higher GB and EE than their counterparts working with inmates not already convicted. Victimizations have a significant effect on GB, EE, D and PA levels. Prison guards with physical or armed aggressions report higher global GB, EE, D and PA levels than prison guards without aggressions. Furthermore, prison guards with physical or armed aggressions report higher global GB and D levels than prison guards with verbal aggressions. Two major points are highlighted by our study. First, characteristics of prison and inmates are related to burnout among prison guards. Second, victimizations lead to burnout.
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The comorbidity between chronic pain and depression is high: in the general population setting, the odds ratio for suffering from one of these disorders when suffering from the other is estimated around 2.5. For chronic pain patients consulting in pain clinics, the comorbidity rate reaches one third to half of the patients. For the International Association for the Study of Pain (IASP), pain consists in an emotional as well as a sensory dimension, both of them have to be assessed systematically. Likewise, affective disorders must be systematically depicted in chronic pain patients. The reasons for such comorbidity are complex and result from the conjunction of common risk factors (environmental and genetic vulnerability factors) and of a bidirectional causality. THE TRANSACTIONAL MODEL OF STRESS AND COPING OF LAZARUS ET FOLKMAN: The appraisal stress model (Lazarus and Folkman, 1984) offers an opportunity to understand how chronic pain can cause depression. Pain is conceptualized as a chronic stress. Its appraisal in terms of loss, injustice, incomprehensibility or changes (primary appraisal), and in terms of control (secondary evaluation) determine how the subject will cope with pain. Several personality traits as optimism, hardiness or internal locus of control play a protective role on these evaluations, whereas others (neuroticism, negative affectivity or external locus of control) are risk factors for depression. Low perceived social support is also related to depression. On the contrary, self-efficiency is linked with low levels of depression. Self-management therapies focus on increase of perceived control of pain by the patient in order to improve his/her motivation to change, and to let the patient become active in the management of his/her pain. ⋯ According to Lazarus and Folkman (1984), coping strategies are the constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing on or exceeding the resources of the person. Pain patients can use a wide variety of pain coping strategies: problem versus emotion focused strategies or cognitive versus behavioural strategies. Some of them are highly dysfunctional, such as catastrophizing (cognitive strategy) or avoidance (behavioural strategy). Their preferential use can lead to the development of a depressive episode. The "fear-avoidance model" (Vlayen, 2000) explains pain chronicization by a vicious circle that begins with the pain catastrophizing; this leads to fear of pain, which in turn leads to avoidance and finally to pain and depression. This is why some behavioural cognitive interventions focus on the reduction of catastrophizing and avoidance. Some functional pain coping strategies were identified: they are active strategies centred on problem resolution such as distraction, reinterpretation or ignorance of pain sensations, acceptance, and exercise and task persistence. New therapeutic interventions focus on the development of better coping strategies such as distraction, relaxation and acceptance.
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This paper summarizes the recent literature on the phenomena of psychogenic non epileptic seizures (PNES). DEFINITION AND EPIDEMIOLOGY: PNES are, as altered movement, sensation or experience, similar to epilepsy, but caused by a psychological process. Although in the ICD-10, PNES belong to the group of dissociative disorders, they are classified as somatoform disorders in the DSM-IV. That represents a challenging diagnosis: the mean latency between manifestations and diagnosis remains as long as 7 years. It has been estimated that between 10 and 30% of patients referred to epilepsy centers have paroxysmal events that despite looking like epileptic episodes are in fact non-epileptic. Many pseudo epileptic seizures have received the wrong diagnosis of epilepsy being treated with anticonvulsants. The prevalence of epilepsy in PNES patients is higher than in the general population and epilepsy may be a risk factor for PNES. It has been considered that 65 to 80% of PNES patients are young females but a new old men subgroup has been recently described. POSITIVE DIAGNOSIS AND PSYCHIATRIC COMORBIDITIES: Even if clinical characteristics of seizures were defined as important in the diagnosis algorithm, this point of view could be inadequate because of its lack of sensitivity. Because neuron-specific enolase, prolactin and creatine kinase are not reliable and able to validate the diagnosis, video electroencephalography monitoring (with or without provocative techniques) is currently the gold standard for the differential diagnosis of ES, and PNES patients with pseudoseizures have high rates of psychiatric disorders such as depression, anxiety, somatoform symptoms, dissociative disorders and post-traumatic stress disorder. We found evidence for correlations between childhood trauma, history of childhood abuse, PTSD, and PNES diagnoses. PNES could also be hypothesized of a dissociative phenomena generated by childhood trauma. ⋯ PNES is a diagnostic and therapeutic challenge that is costly to patients and to society at large. Further studies are needed to understand this dissociative psychiatric disorder and to propose therapeutic guidelines.
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The factitious disorders, more commonly known as pathomimia, are mainly expressed as organic symptoms voluntarily induced by the patient. Patients suffering from these disorders do not seek to obtain immediate secondary benefits, contrary to simulation. They send the physician a challenge, sometimes by means of self-mutilation, or exposure to a vital risk. Their objective is to raise the interest and the mobilization of the medical community. The patient will develop intense relationships with the medical staff, technically mobilized as well as emotionally, as far as the factitious character of the disorder is uncovered. In some cases, factious disorders are conditions in which a person acts as if he or she has a psychiatric disorder, by deliberately exhibiting psychiatric symptoms. Most often described are factitious acute psychotic disorders, mourning, affective disorders and post-traumatic stress disorders. Psychiatric factitious disorders are difficult to diagnose, but they share common diagnosis criteria with other pathomimias. These subjects may suffer from pathomimia because of the occurrence of other psychiatric symptoms, such as pathological personalities, adaptation disorders, abuse and/or dependence on alcohol or other substances, or depressive disorders. This paper describes three clinical cases of pathomimia, diagnosed after hospitalization in a psychiatric unit for depressive symptoms, as a correlate to their factitious or authentic character. ⋯ These three cases indicate that a real depressive syndrome may be observed with a patient suffering from pathomimia. Therefore, a neutral and complete psychiatric evaluation is necessary so as to not deprive these patients from the opportunity for an adapted treatment.