[Isolation and restraint in units for difficult patients and in psychiatric intensive care units]. / Isolement et contention en unités pour malades difficiles et en unités de soins intensifs psychiatriques.

The units for difficult patients (UMD) and the intensive psychiatric care units (Usip) are psychiatric services that are not successively sectorized, created to meet the needs of intensive care in a closed environment and sometimes of a forensic nature. These two systems are used to care for patients whose clinical condition often makes it too complex to maintain them in sector psychiatric units, and many of their operating rules differ. This is not the case for seclusion and restraint measures and the application of the law governing these measures.

[Soothing in units for difficult patients and in psychiatric intensive care units]. / Apaisement en unités pour malades difficiles et en unités de soins intensifs psychiatriques.

In the units for difficult patients (UMD) and the intensive psychiatric care units (Usip), patients whose mental pathologies have or could generate violent acts which can go as far as committing homicide are taken care of. If, during the psychiatric care of these patients, isolation and restraint measures can be put in place as a last resort, in general it is the symptomatological and behavioral appeasement of these persons that is sought in an alternative way.

[Professional commitment and work in psychiatry]. / L'engagement professionnel et le travail en psychiatrie.

The practice of care in a psychiatric service, whether outpatient or inpatient, appears more than ever to be a personal commitment. How can we conceive it despite the difficulties of the profession, which make new professionals hesitate to join it? There is now open talk of a "crisis in psychiatry", of professionals leaving the profession. However, many observers and caregivers manage to give meaning to this demanding profession, at the crossroads between disciplines and institutions. The activity is constantly evolving, shaped as much by the advent of multiple theoretical frameworks as by societal movements. The number of people using this discipline, which is now also called "mental health" care, is constantly increasing, while at the same time all the players are struggling to recruit professionals. However, patients who have become users can testify to the quality of the caregivers.

[Psychiatric intensive care units]. / Les unités de soins intensifs psychiatriques.

The intensive psychiatric care units are intermediate health structures between the sector psychiatric services and the units for difficult patients. Prisoners can be treated there under article D. 398 of the Code of Criminal Procedure.

[Hysteria: history of a concept and its clinical reality]. / L'hystérie : histoire d'un concept et de sa réalité clinique.

Hysteria is one of the oldest and best known clinical terms. Its history reveals the extent to which pathological entities, some more than others, are the fruit of successive conceptions of experts, themselves undoubtedly influenced by the prevailing currents of thought of their time. From its uterine origin to its psychogenic etiology, here is the history of hysteria and its controversies. A history that belongs to that of medicine, neurology, psychiatry, psychology and psychoanalysis.

[Psychiatric care secure units and sexuality of patients.] / Institution psychiatrique fermée et sexualité des patients.

The desire for emotional and/or sexual relations, although universally felt, is not freely expressed because it's usually shaped by modesty, taboos, the norms and values of the surroundings and of the cultural environment of the people who feel such a desire. It is even constrained, or repressed, by certain laws. This complexity can be significantly increased by the existence of mental health disorders requiring psychiatric care in secure units. Certain notions must be taken into account, such as the relative freedom of patients, compliance with rules, discernment, informed consent, the vulnerability of potential partners, the impact of treatments, etc.

[Non-compulsory outpatient care programmes: two clinical illustrations]. / Programmes de soins ambulatoires sans consentement : deux illustrations cliniques.

The act of 5 July 2011 pertaining to the rights and the protection of persons under psychiatric care presents the possibility for compulsory care, without the need for full hospitalisation. Patients can be cared for through partial hospitalisation (day hospital and part-time therapeutic clinic) or in a medical-psychological centre. Treatments and all care are detailed in a care programme. This programme is sent, like all certificates, to the regional health agency and the prefecture in the case of psychiatric care by decision of the State representative, or to the hospital director for psychiatric care at the request of a third party. We propose two clinical vignettes.

[Isolation and protection, a contradiction and a necessity]. / Isolement et protection, une contradiction et une nécessité.

The association of the two terms 'isolating' and 'protecting', seems counterintuitive. The practice of isolation conjures up images of an asylum or even prison, rather than a notion of safeguarding. Isolation is defined within caregiving institutions by a vast range of practices, neither rare nor recent. It is used in a variety of departments, from psychiatric isolation to septic isolation or a form of isolation common to both: social isolation resulting from institutionalisation.

[Perpetrators and victims of sexual violence]. / Violences sexuelles agies, violences sexuelles subies.

Shaped by culture and education, human sexuality is organised around the principle of mutual consent, and other limits fixed by the law, between partners in emotional exchanges and sexual relationships. When this is not the case, complex issues of sexual violence, inflicted and suffered, arise. Certain health professionals then become involved, working either with the perpetrator and/or the victims of this violence. The care can be complicated because these professionals do not know the reality of the situations described. Caution and a critical distance must therefore accompany their assessments and their clinical actions.

[Sanitary answers given to prisoners]. / Réponses sanitaires proposées aux personnes incarcérées.

A methodological guide, updated in January 2018, outlines the responses jointly organized by the prison administration and the Ministry of Health to meet the health needs of prisoners. These care needs are significant and diverse, as are those of the rest of the population. The resources available for psychiatric care / support are often lower than the needs identified in the health units. Similarly, care on the geriatric side often becomes necessary.

[Therapeutic approaches in court-ordered therapy]. / Les approches thérapeutiques dans l'injonction de soins.

As is the case with other contexts of mental health treatments, the therapeutic approaches to court-ordered therapy are varied. They are based on the principle of their clinical indication and must be delivered by therapists trained in the specific area. The classic therapeutic approaches are used: medication, psychoanalysis and psychoanalytically inspired therapies, cognitive behavioural therapies, group therapies and body-oriented approach.