Encephale
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The process of disinstitutionalization combined with the economic reality is responsible for the great upheaval in taking care of psychiatric patients. The repercussions are worldwide, national, and local concerning the Philippe Pinel Psychiatric Hospital (Amiens, Somme) place of this work. So the psychiatrists of this institution have to do with the following datas: a reduction of the admissions between 1991 et 1998 (around 1,5%) and a provided reduction of the hospitalization capacities upper to 40% for the following two years. ⋯ Two facts command attention now: we must clearly define the type of patients who have really benefited of this brief hospitalization, with the object of being able to plan this strategy. By another way, it seems that a brief hospitalization, just like any hospitalization, is one part of our patients curing process for the two groups. Therefore, the choice of a psychiatric hospitalization becomes a debatable point, through the treatment of a psychiatric emergency.
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Perfectionism is a dimension which has been studied very little as a separate entity. It is not even considered as a nosological factor. No classification of the medical sciences underlines its importance other than to speak of a personality trait, of an aspect, or of a parameter. ⋯ In conclusion, providing some modifications according to semantics, the choice of a four factor solution allows for confirmation of the original structure of MPS and for internal consistency. The different components of MPS vary according to gender: SOP and more OOP discriminate men and women; SPP allows for differentiating women with failure. A structural model enhances the role of perfectionism in the cognitive and behavioural contexts; for instance it clarifies its action on fear of failure and success rates according to gender.
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Case Reports
[Frontal dementia or dementia praecox? A case report of a psychotic disorder with a severe decline].
Many authors have described these last years the difficulty to establish a differential diagnosis between schizophrenia and frontotemporal dementia. However treatment and prognosis of these two separate diseases are not the same. Schizophrenia is a chronic syndrome with an early onset during teenage or young adulthood period and the major features consist of delirious ideas, hallucinations and psychic dissociation. However a large variety of different symptoms describes the disease and creates a heterogeneous entity. The diagnosis, exclusively defined by clinical signs, is then difficult and has led to the research of specific symptoms. These involve multiple psychological processes, such as perception (hallucinations), reality testing (delusions), thought processes (loose associations), feeling (flatness, inappropriate affect), behaviour (catatonia, disorganization), attention, concentration, motivation (avolition), and judgement. The characteristic symptoms of schizophrenia have often been conceptualised as falling into three broad categories including positive (hallucination, delision), negative (affective flattening, alogia, avolition) and disorganised (poor attention, disorganised speech and behaviour) symptoms. No single symptom is pathogonomonic of schizophrenia. These psychological and behavioural characteristics are associated with a variety of impairments in occupational or social functioning. Cognition impairments are also associated with schizophrenia. Since the original clinical description by Kraepelin and Bleuler, abnormalities in attentional, associative and volitional cognitive processes have been considered central features of schizophrenia. Long term memory deficits, attentional and executive dysfunctions are described in the neurocognitive profile of schizophrenic patients, with a large degree of severity. The pathophysiology of schizophrenia is not well known but may be better understood by neuronal dysfunctions rather than by a specific anatomical abnormality. Frontotemporal lobar degeneration (FTLD) is one of the most common causes of cortical dementia. FTLD is associated with an anatomical atrophy that can be generalised, with a frontotemporal or focal lobar predominance. Histologically there is severe neuronal loss, gliosis and a state of spongiosis. In a minority of case Pick cells and Pick bodies are also found. The usual clinical features of FTLD are divided in three prototypic syndromes: frontotemporal dementia (FTD), progressive non-fluent aphasia (PA) and semantic dementia (SD). FTD is the most common clinical manifestation of FTLD. FTD is first characterised by profound alteration in personality and social conduct, characterised by inertia and loss of volition or social disinhibition and distractibility. There is emotional blunting and loss of insight. Speech output is typically economical, leading ultimately to mutism, although a press of speech may be present in some overactive, disinhibited patients. Memory is relatively preserved in the early stage of the disease. Cognitive deficits occur in the domains of attention, planning and problems solving, whereas primary tools of language, perception and spatial functions are well preserved. PA is an initial disorder of expressive language, characterised by effortful speech production, phonologic and grammatical errors. Difficulties in reading and writing also occur but understanding of word meaning is relatively well preserved. In SD a severe naming and word comprehension impairment occur on the beginning in the context of fluent, effortless, and grammatical speech output. There is also an inability to recognise the meaning of visual percepts. The clinical syndromes of FTLD are associated with the brain topography of the degeneration. So considerable clinical overlap can exist between schizophrenia and FTLD and the object of the following case report is to remind the difficulty to make a differential diagnosis between these two pathologies. ⋯ A differential diagnosis between schizophrenia and FTLD is difficult to establish. Schizophrenia is a heterogeneous disease with a large variety of cognitive dysfunctions. Neurocognitive tools may improve our knowledge of schizophrenia.
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Review
[Caregiver burden in relatives of persons with schizophrenia: an overview of measure instruments].
The high prevalence and chronic evolution of schizophrenia are responsible for a major social cost. The adverse consequences of such psychiatric disorders for relatives have been studied since the early 1950s, when psychiatric institutions began discharging patients into the community. According to Treudley (1946) "burden on the family" refers to the consequences for those in close contact with a severely disturbed psychiatric patient. ⋯ The instrument should be developed from the caregiver's point of view and be derived from qualitative interviews with relatives of patients suffering from schizophrenia. It's responsiveness should be documented before inclusion in clinical trials or evaluation of psychoeducational programs. We are now working with the National Union of Friends and Families of Patients to validate an instrument in french language.
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The Verona Service Satisfaction Scale-French version (13) was translated and adapted from the Italian version of Verona Service Satisfaction Scale (27). The VSSS makes it possible to evaluate the satisfaction of people with serious mental illness with respect to the services. The original VSSS-54 contained 7 dimensions: 1) Overall satisfaction, 2) Professionals' skills and behaviour, 3) Information, 4) Access to services, 5) Services efficacy, 6) Relatives' involvement and 7) Types of interventions. According to factorial analyses carried out by Ruggeri et al., the dimensions Information and Access to services were aggregated. However, no factorial analysis was carried out in order to verify the six dimension-structure of the VSSS. From an international perspective, the study entitled "The European Psychiatric Services: Inputs linked to Outcome Domains and Needs (EPSILON)" achieved the standardisation of different questionnaires in several languages (2). A new version of the VSSS entitled "Verona Service Satisfaction Scale-European version" (VSSS-EU) was developed and is now available in the following languages: Italian, Danish, German, English and Spanish. In order to compare in different countries the satisfaction of people with serious mental illness with respect to services, we undertook from 1998 to ascertain the psychometrical properties of the French version of the VSSS. (13). Confirmatory Factorial Analysis (CFA) was carried out on the six dimension-structure of the VSSS-54F: 1) Overall satisfaction, 2) Professionals' skills and behaviour, 3) Information and Access to services, 4) Services efficacy, 5) Relatives involvement and 6) Types of interventions. For each dimension, consistency analysis (Cronbach's alpha) was computed in order to bring forth additional psychometrical properties of the VSSS-54F. ⋯ This study confirms with some adjustments the factorial structure of the VSSS. The results indicate five dimensions (25 items): Psychiatrists/Psychologists' skills and behaviour, Nursing staff/social workers' skills and behaviour, Information and access to services, Services efficacy, Relatives' involvement. Even if the Type of interventions dimension was not retained in the model, we suggest preserving it for eventual clinical evaluation based on each item. We also suggest, for future studies, the adaptation of the VSSS-54F to the European version, VSSS-EU. Indeed, the results of our study sustain the European version because the VSSS-EU is more focused since it separates the skills and behaviour of psychiatrists, psychologists, nurses and social workers (e.g. items 3a and 3b or items 22a and 22b). The next step in the validation process would be to measure Inter-rater and test-retest reliability as well as concurrent, convergent and discriminant validity of the VSSS-EU. Furthermore, a multicultural comparison of the VSSS-EU would be required if the instrument is used for interesting comparisons of survey.