Presse Med
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INDICENCE: Cervical artery dissection (CAD) is one of the major cause of cerebral infarction before 45 years of age. The average annual incidencerate is between 2.5 and 3 per 100,000, but the reported incidence of CAD is probably underestimated because of frequent asymptomatic forms, or producing only minor and local symptoms. Dissection of the internal carotid artery (ICA) is more frequent than dissection of the vertebral artery (VA) and intracranial dissection is less frequent than extracranial dissection.
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GENERAL DATA: The clinical manifestations and neuropathological signs of multiple sclerosis have been recognized for more than one hundred years, but the cause remains unknown.
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BRIEF HISTORY: The definition of suicide differs depending on the era, author or theory. Society's attitude has varied throughout history. When psychiatry appeared in the nineteenth century it medicalized the problem. First with Esquirol in 1838, followed by Delmas in 1932. Whereas Durkheim, with his theory of anomia in 1897, defended the sociological position presented in the form of a law: the percentage of suicides increases in inverse proportion to the social integration of the individual and one should not forget Halbwachs (1930) in this debate. Re-medicalization was mainly due to Deshaies in 1947, who dismissed the excessiveness of these two trends, while remaining open to them. According to his theory, "suicidal equivalences" should also be taken into account, even if the individual's death wish is subconscious. CONTRIBUTION OF THE PSYCHOANALYTICAL THEORY: This contribution is considerable and has gone through several stages. Currently, psychoanalysts accept the influence of extrinsic factors in suicidal behavior. This is the case, for example, for the pre-morbid states or the initiating factors, the importance of which are no longer denied and which favor regression and destruction of the personality and resulting in suicidal behavior. DOES A CLINICAL PROFILE EXIST?: Fifteen percent of depressive patients commit suicide. With regard to the act itself, it is far more dangerous and violent in the elderly than in young adults. The suicide rate of elderly people is 2-fold greater than that of the general population. Suicidal equivalents consist in letting oneself die, because of the loss in will to fight that characterizes the classical syndrome of this attitude. ⋯ In France there are around 12,000 suicidal deaths per year among 150,000 suicide attempts, i.e., 1 attempt every 4 minutes and 1 suicide every 40 minutes. This corresponds to a raw mortality rate of 20 out of 100,000 inhabitants. However, epidemiologists consider that these figures are underestimated by around 20%. Since 1983, they exceed the mortality rate caused by road accidents (8,000/year in France). MISINTERPRETED DEPRESSION: Most suicides result from depression that was not recognized and treated as such. Clinical intuition is essential. It is the risk of suicide that renders the diagnosis of depression urgent. Retrospective surveys show that 50% of individuals having attempted suicide had consulted a doctor the month preceding their act. It is therefore important to organize the prevention of such risks. When depressive patients do not express any suicidal tendency, it is essential to raise the subject. In most cases, verbalization relieves the patients. However the eventual hospitalization of such patients should always be boum in mind.
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RISKS RELATED TO HANDLING: Cytostatic drugs (CS) destroy malignant cells. However, they also have deleterious effects on healthy cells. ⋯ WHAT TYPE OF RISKS?: Laboratory staff and nurses handling these molecules are exposed to sub-therapeutic concentrations of these products, which induce little known biological effects. Cytostatics can provoke allergies, mutations and probably have carcinogenic and teratogenic effects.
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AN EXPLANATION OF DISAPPOINTING Handling obesity and moderate overweight with dietary prescriptions or cognitive and behavioral therapies gives unsatisfying results. For some, such treatments even have the drawback of aggravating eating behavioral patterns, not to mention other psychopathological disorders. We believe, on the contrary, that such disappointing results and troubles may be explained by the cognitive restraint theory. ⋯ In the former case, one can distinguish: a) a voluntarist stage in which the individual deliberately chooses not to heed his hunger and satiety sensations in order to privilege rules that are supposed to allow him/her to control his/her weight; b) an unconscious stage during which physiological sensations are blurred, and eating habits ruled by unconscious cognitive processes and emotions. The individual thus ends up organising his eating behaviour around his/her fear of lacking, the frustration/guilt doublet and troubles in the comforting pattern. Such a state of inhibition is frequently interspersed with losses of control, described as hyperphagic or bulimic bouts and compulsive eating.