[Adjustment disorder and DSM-5: A review]. / Le trouble de l'adaptation et le DSM-5 : une revue de la littérature.

INTRODUCTION: This paper exposes the complexity and discrete characteristic of the adjustment disorder with reference to its clinical and scientific diagnosis. Even though the disorder occurs in frequent clinical circumstances after important life events, such as mobbing, burn-out, unemployment, divorce or separation, pregnancy denial, surgical operation or cancer, the adjustment disorder is often not considered in the diagnosis since better known disorders with similar symptoms prevail, such as major depression and anxiety disorder. Ten years ago, Bottéro had already noticed that the adjustment disorder diagnosis remained rather uncommon with reference to patients he was working with while Langlois assimilated this disorder with an invisible diagnosis. METHODOLOGY: In order to maximize the data collection, we used the article review below and challenged their surveys and results: National Center for Biotechnology Information (NBCI - Pubmed) for international articles and Cairn.info for French literature. Moreover, we targeted the following keywords on the search engine and used articles, which had been published from 1 February 1975 to 31 January 2015: "adjustment", "adjustment disorder" and the French translation "trouble de l'adaptation". RESULTS: One hundred and ninety-one articles matched our search criteria. However, after a closer analysis, solely 105 articles were selected as being of interest. Many articles were excluded since they were related to non-psychiatric fields induced by the term "adaptation". Indeed, the number of corresponding articles found for the adjustment disorder literally pointed-out the lack of existing literature on that topic in comparison to more known disorders such as anxiety disorder (2661 articles) or major depression (5481 articles). This represents up to 50 times more articles in comparison to the number of articles we found on adjustment disorder and up to 20 times more articles for the eating disorder (1994), although the prevalence is not significantly higher than for the adjustment disorder. According to their relevance and their content, we have split the articles into seven subcategories: 1. General description: most scientific articles generally describe the adjustment disorder as being a transition diagnosis, which is ambiguous, marginal and difficult to detect. The findings claim that only a few studies have been conducted on the adjustment disorder despite a high prevalence in the general population and in the clinical field. 2. CLASSIFICATION: the DSM-5 defined the adjustment disorder as a set of different outcomes and syndromes induced by stress after a difficult life event. While the link to other disorders has not been mentioned, the diagnosis of this disorder is no longer excluded or perceived as a secondary diagnosis. The DSM-5 faced criticism from three points of view: the operationalization of the concept of stress, the differential diagnosis and the description. 3. Prevalence: different samples have shown a significantly high prevalence of the adjustment disorder within the population. In addition to the psychiatric pain induced by difficult life events we need to emphasize the fact that 12.5 to 19.4 percent of the patients faced heavy and severe pathologies and depended on clinical care and treatment. 4. Etiology, comorbidity or associated symptomatology: the literature identified the tendency to commit suicide and stressful life events as being two fundamental characteristics of adjustment disorder. The third one is the personality profile. 5. DIFFERENTIAL DIAGNOSIS: that motivates researchers to focus on the adjustment disorder: the differentiation approach as to the major depression. Indeed, the aetiology, the symptomatology and the treatment differ from the adjustment disorder. 6. ASSESSMENT: very recently, Dutch researchers have developed and validated the Diagnostic Interview Adjustment Disorder (DIAD). 7. TREATMENT: in 2014, no data or meta-analysis recommended drug treatment in addition to therapy. In fact, several authors have demonstrated the ineffectiveness of drug therapy. The literature suggests a psychotherapeutic approach to treat adjustment disorder. CONCLUSION: Emotional reactions triggered by life events are responsible for full therapy agendas and for the rush in emergency rooms and hospitals. The reflex when faced with crying, insomnia or suicidal thoughts to give a diagnostic of major depressive disorder s is generally accepted by everyone. The elevated risk to commit suicide and the approved success of remission or healing through treatment (psychotherapy) are two major reasons why several studies promote the importance and the need to identify the adjustment disorder of our patients.

[Effectiveness of physical exercise in psychiatry: a therapeutic approach?]. / Efficacité de l'exercice physique en psychiatrie : une voie thérapeutique ?

INTRODUCTION: There is a general belief that physical activity and exercise have positive effects on mood and anxiety. Intervention studies describe an anxiolytic and antidepressive effect of exercise in healthy subjects and patients. However, the majority of published studies have substantial methodological inconsistencies. Our review of the literature showed the importance of distinguishing three items in studies regarding efficacy of physical exercise in psychiatry: operationalisation of concepts (duration, frequency, intensity, type of exercise), the type of disorder, the diagnosis, and exploratory hypotheses. The aim of this article is to demonstrate that physical exercise in the psychiatry department contributes to the improvement of the mental health of in-hospital patients. METHODS: Sociodemographical data, the diagnosis and the physical exercise (duration, distance, type and frequency) of 283 in-hospital patients in the psychiatry department were listed. Physical exercise (cycling, long walks, short walks, soft and hard gymnastics) included in a database has been proposed to patients for many years in this hospital. After their hospitalisation, the members of the medical staff (20 persons) evaluated the patients on a visual analogic scale from 1 to 10 related to the improvement of their mental health. No experimental manipulation was made. SUBJECTS: One hundred and twenty-eight men, mean age: 45.67 years (± 13.59) exhibited the following disorders: major depressive disorder (117), anxious disorders (25), alcoholic addiction (85), toxicomania (10), psychotic decompensation (33), bipolar disorder (3) and others (10). Patients practised at least one exercise during their hospitalisation, mean duration of 15.93 (± 9.18) working days. The frequency of physical exercises per patient was 5.65 (± 6.20). The improvement of each patient was evaluated around six times (6.16 ± 3.83). The average amelioration score for all the patients was close to 50% (4.99 ± 1.65). RESULTS: Correlations between the improvement of mental health and participation in physical exercises were all significant (frequency: r=0.228; P<0.001; duration: r=0.236; P<0.001; distance: r=0.201, P=0.001). In comparison with psychotic patients, drug addiction and alcoholic, depressive patients showed greater interest in physical exercise. This is similar for anxious disorders. According to the results, two groups were created regarding their improvement (cut out point: 5.08). We observed that patients suffering from major depression considerably improved thanks to physical exercise (P=0.048), spent more time practising (P=0.037) and walked or cycled greater distances (P=0.038). Finally, cycling (frequency: P=0.008; distance: P=0.016; duration: P=0.011) and "hard" gymnastics were the physical exercises which optimized the results. DISCUSSION: Physical exercise is correlated with the improvement of mental health. The practice of physical exercise depends on the mental disorder. People suffering from major depressive disorder benefit more from physical exercise than other groups. Cycling and "hard" gymnastics are both exercises to be proposed in every programme. CONCLUSION: To practice physical exercise during hospitalisation in a psychiatric department has a positive influence on the symptomatology, and contributes to the improvement of mental health.

[Improving doctor's communication skills in oncology: review and future perspectives]. / Améliorer les stratégies de communication des médecins en oncologie: état des lieux et perspectives futures.

The aim of this review is to discuss the different communication skills training designed to physician interactions with cancer patients. The development of medicine and chronic cancer treatments indicates the need to improve communication skills that combine appropriate assessment, information and support. Literature shows however that numerous factors may jeopardize the mastery of those skills. As a consequence, initiatives have been made to improve oncologists' communication skills. The objectives of those training programs are to improve patients' as well as the medical staffs' quality of life. A critical review of objectives and used techniques (theorical information, case discussion, role playing, feed-back) is presented here. This review includes also the discussion about training module integrating several techniques. This review shows the efficacy of experiential techniques as well as participative techniques. The results of available studies are finally emphasizing two difficulties: the maintenance and the consolidation of the various skills acquired over time and their successful transfer to the clinical practice.

[Breast cancer and its psychological approach: family, others, chance and...me]. / Le cancer du sein et son approche psychologique: la famille, les autres, la chance et ... moi.

Since several years already, the scientific literature evoked the psycho-oncological perspective in the psychotherapeutic treatment of the patient suffering of a malignant mammary pathology. The objective of this article is to insist on some characteristics of personality inherent to the individual that suffers of a malignant mammary pathology. Comparing three groups of women (malignant mammary pathology--n = 51, benign mammary pathology--n = 71 and a group controls--n = 30), a set of questionnaires relating to locus of control and to the close circle--family and couple--has been managed. Results indicate that the woman suffering of a breast cancer is less "intern", consider that her health depends on factor "luck" and wish less cohesion and therefore more of distance within her couple and her family.

[Alexithymia, health and psychopathology]. / Alexithymie, santé et psychopathologie.

The term "alexithymia" is derived from the Greek and means "no words for feeling". Coined by Sifneos in 1972, alexithymia refers to a relative narrowing in emotional functioning. The salient clinical features of alexithymia include difficulties in recognizing and verbalizing feelings, endless description of physical symptoms instead of émotions, concrete speech and thought closely tied to external events, paucity of fantasy life. Although initially described in the context of psychosomatic illness, alexithymic characteristics may be observed in patients with a wide range of medical and psychiatric disorders. This study purpose to investigate the relationship between alexithymia and concepts of health's psychology: locus of control, family's cohesion and adaptability, personality's concepts,... Three groups of patients were established on base of their diagnosis: depression (n = 16), alcoholism (n = 16) and control group (n = 16). The following measures were administered: family's cohesion and adaptability (Olson), Multidimensional Health Locus of Control (Wallston and Wallston), externality scale (Rotter), Minnesota Multiphasic Personality Inventory. The results show alexithymic personality is less internal (t = 2.72; p = 0.011) than non-alexithymic subject (m = 20.88 +/- 6.19 vs m = 26.06 +/- 4.52). Furthermore the family's cohesion is lower (t = 2.961; p = 0.008) for the alexithymics than the non-alexithymics (m = 30.46 +/- 10.38 vs m = 40.27 +/- 5.44). This conclusions added to the more pathological personality's profile (11 scales on 14 were significant higher for for alexithymics) of alexithymics at the MMPI indicate alexithymia's concept is central in psychopathology if measures used are issued by the health's psychology.

[Psychological approach to different skin diseases: life events and tendency to complain]. / Approche psychologique de différentes dermatoses: événements de vie et propension à se plaindre.

BACKGROUND: For nearly two decades, dermatology has associated with psychology to find a better way to care for dermatology conditions. A scientific trend called psychosomatics is creating a link between dermatology and psychology. OBJECTIVE: The purpose of this article was to examine two concepts closely linked to psychodermatology (life events and tendency to complain) and to emphasize the difference between factors playing a role in the onset of certain skin diseases (psoriasis, alopecia areata, benign tumors, eczema). RESULTS: We found that psoriasis patients have a greater tendency to complain than people with the other disease. This point to the importance of taking emotions into account when studying psoriasis. We also found that life events play a role in the onset of psoriasis and alopecia areata. Moreover, these events were anterior by more than 12 months in alopecia patients. CONCLUSION: We propose exploring emotions in psoriasis patients and life events over the prior year in alopecia areata patients.

[For or against peridural analgesia?: a psychological approach based on the parturient's needs]. / Pour ou contre la péridurale?: une approche psychologique de la demande de la parturiente.

The present study investigates why some women, before and during delivering, request peridural analgesia or, on the contrary, refuse it. On the basis of a literature review and of an empiricial study involving 57 women, a psychological differentiation is attempted to discriminate users from non-users of peridural analgesia. Pain perceptions, health locus of control, when internal (IHLC), family and couple adaptability appear to be discriminating factors. Our results indicate a higher chance locus of control (externality) in non-users then in users, as well as a more rigid couple functioning. The incidence of Internal Health Locus of Control of pain perception is outlined.