[Intimate partner violence: suffering for the child, a challenge for parenthood]. / Violence dans le couple : une souffrance pour l'enfant, un défi pour la parentalité.

Intrafamily violence has a significant impact on the child's neurobiological, psychological and social development. While psychosomatic and psychotraumatic suffering is frequent, parenthood is also impacted, caught up in this context of violence. The support provided to the children and the couple must respond to specific practices.

[The general practitioner's role in identifying and supporting female victims of violence]. / Repérage et accompagnement par le médecin généraliste des femmes victimes de violences.

Violence has a major impact on the health of victims and can be masked by various psychological and somatic pathologies. Systematic questioning by general practitioners gives women the opportunity to be finally heard and enables doctors to make the connection with the violence to which they are being subjected. Identifying this abuse is essential in order to be able to help and orient the women towards the appropriate support.

[Systematic screening for domestic violence in the accident and emergency department]. / Dépistage systématique des violences conjugales an seirvice d'accueil des urgences.

The accident and emergency department is a place where female victims of domestic abuse may arrive with various symptoms. The systematic screening of female victims was studied and implemented by an A&E team in the Paris region and has now been extended to all the hospital's departments where female victims may arrive for treatment.

The trade-off between costs and quality of care in the treatment of psychosomatic patients with somatoform pain disorder.

BACKGROUND: The introduction of efficiency-oriented provider payment systems in inpatient mental healthcare in various Western countries may lead to the use of less healthcare resources in the treatment of patients. To avoid unintended effects on quality of care that may result from reductions in resource utilization, it is essential for decision and policy makers to know whether there is a trade-off between costs and quality of care. AIM OF THE STUDY: The aim of this study was to investigate and quantify the relationship between costs and outcomes in psychosomatic inpatients with somatoform pain disorder. METHODS: The inclusion criteria for patient selection (n = 101) were (i) a main diagnosis of somatoform pain disorder according to International Classification of Diseases-10 (ICD-10) [F45.4, F45.40, F45.41]; (ii) complete data on the mental component summary reflecting overall functioning of mental health (MCS-8) measured with the Short Form-8 Health Survey (SF-8) within 3 days of the admission and discharge dates; and (iii) treatment at Charité Universitaetsmedizin (Berlin, Germany) during the period January 2006-June 2010. The change in the MCS-8 score incurred over the treatment period was used as an indicator of quality of care. Treatment costs were calculated from the provider's perspective, mainly using bottom-up micro-costing. The year of valuation for cost calculation was 2008 (with no inflation adjustment); for costs provided by the accounting department for services consumed by the patient, the valuation year was based on the year of service provision. We hypothesized that the outcome 'change in MCS-8 score' was a function of the independent variable costs, patient characteristics, socio-demographic variables, pain-related variables, co-morbidities and subjective illness attribution, i.e. whether patients attributed the origin of pain mainly to a somatic cause or not. An interaction term between costs and illness attribution was included to control for the hypothesized differing effects of resource input or costs on the outcome variable conditional on patients' illness attribution. Hausman tests indicated that endogeneity was not present, thus, ordinary least squares regression (OLS) was conducted. We assessed whether the change in the MCS-8 score was clinically meaningful and perceptible by the patient, using the minimal clinical important difference (MCID). For Short Form Health Surveys, the MCID for changes in the mental component summary is typically around 3 points. RESULTS: We found a trade-off between costs and outcome for patients without or with only minor somatic illness attribution (77 % of the sample). This patient group improved 0.4 points in outcome after every 100 increase in total costs per case (F 1,77 = 13.836, t(77) = 3.72, p = 0.0004). For patients with mainly somatic illness beliefs (23 % of the sample), we did not find a trade-off between costs and outcome. CONCLUSION: For the majority of patients, we found a trade-off between costs and health outcome, thus, it seems advisable to carefully monitor outcome parameters when applying cost containment measures.

[Liaison psychiatry nurse: the development of supervision in somatic medicine]. / Infirmier en psychiatrie de liaison : développement de la supervision en milieu somatique.

BACKGROUND: Over the years, somatic care has become increasingly specialized. Furthermore, a rising number of patients requiring somatic care also present with a psychiatric comorbidity. As a consequence, the time and resources needed to care for these patients can interfere with the course of somatic treatment and influence the patient-caregiver relationship. In the light of these observations, the Liaison Psychiatry Unit at the University Hospital in Lausanne (CHUV) has educated its nursing staff in order to strengthen its action within the general care hospital. What has been developed is a reflexive approach through supervision of somatic staff, in order to improve the efficiency of liaison psychiatry interventions with the caregivers in charge of patients. The kind of supervision we have developed is the result of a real partnership with somatic staff. Besides, in order to better understand the complexity of interactions between the two systems involved, the patient's and the caregivers', we use several theoretical references in an integrative manner. PSYCHOANALYTICAL REFERENCE: The psychoanalytical model allows us to better understand the dynamics between the supervisor and the supervised group in order to contain and give meaning to the affects arising in the supervision space. "Containing function" and "transitional phenomena" refer to the experience in which emotions can find a space where they can be taken in and processed in a secure and supportive manner. These concepts, along with that of the "psychic envelope", were initially developed to explain the psychological development of the baby in its early interactions with its mother or its surrogate. In the field of supervision, they allow us to be aware of these complex phenomena and the diverse qualities to which a supervisor needs to resort, such as attention, support and incentive, in order to offer a secure environment. SYSTEMIC REFERENCE: A new perspective of the patient's complexity is revealed by the group's dynamics. The supervisor's attention is mainly focused on the work of affects. However, these are often buried under a defensive shell, serving as a temporary protection, which prevents the caregiver from recognizing his or her own emotions, thereby enhancing the difficulties in the relationship with the patient. Whenever the work of putting emotions into words fail, we use "sculpting", a technique derived from the systemic model. Through the use of this type of analogical language, affects can emerge without constraint or feelings of danger. Through "playing" in that "transitional space", new exchanges appear between group members and allow new behaviors to be conceived. In practice, we ask the supervisee who is presenting a complex situation, to design a spatial representation of his or her understanding of the situation, through the display of characters significant to the situation: the patient, somatic staff members, relatives of the patient, etc. In silence, the supervisee shapes the characters into postures and arranges them in the room. Each sculpted character is identified, named, and positioned, with his or her gaze being set in a specific direction. Finally the sculptor shapes him or herself in his or her own role. When the sculpture is complete and after a few moments of fixation, we ask participants to express themselves about their experience. By means of this physical representation, participants to the sculpture discover perceptions and feelings that were unknown up to then. Hence from this analogical representation a reflection and hypotheses of understanding can arise and be developed within the group. CONCLUSION: Through the use of the concepts of "containing function" and "transitional space" we position ourselves in the scope of the encounter and the dialog. Through the use of the systemic technique of "sculpting" we promote the process of understanding, rather than that of explaining, which would place us in the position of experts. The experience of these encounters has shown us that what we need to focus on is indeed what happens in this transitional space in terms of dynamics and process. The encounter and the sharing of competencies both allow a new understanding of the situation at hand, which has, of course, to be verified in the reality of the patient-caregiver relationship. It is often a source of adjustment for interpersonal skills to recover its containing function in order to enable caregiver to better respond to the patient's needs.

Clinical profile of people referred to mental health nurses under the Mental Health Nurse Incentive Program.

The Mental Health Nurse Incentive Program (MHNIP) was established in Australia during 2007. The program enables mental health nurses to work in partnership with general practitioners (GPs) in the assessment and treatment of people with severe mental health problems. This paper provides insights into the demographic and clinical profile of 403 people enrolled in the MHNIP in the Ipswich area of Queensland. The clinical presentation (illness severity and symptoms) of those referred to the MHNIP is compared to that of: (i) people referred to a related program known as Access to Allied Psychological Services (ATAPS); and (ii) to clients admitted to acute inpatient care in Queensland. While people referred to the MHNIP presented with more severe problems than those referred to ATAPS, they had less severe problems than those admitted to acute inpatient care. The findings indicate that the MHNIP is meeting the needs of people with complex mental and physical health problems. Further evaluation work is required to determine if the findings from this study can be generalized more broadly. At the national level, consideration should be given to the routine collection of clinical, cost, and demographic data to enable the ongoing monitoring of the program.

Workplace bullying influences women's engagement in the workforce.

Workplace bullying creates hostile work environments, affects mental and physical health, and has social, economic, and career implications. Over 70% of targets of workplace bullying become unemployed either by losing their jobs or by leaving voluntarily. In a grounded theory study, we explored how experiencing workplace bullying and its health consequences affected 40 Canadian women. Further, I examined whether women stayed at or left workplaces after being bullied, how they left, and the influences on whether they stayed or left. Implications of this study are that bullied women and the organizations for which they work need to be assisted to manage this experience more effectively.

[The psychiatric liaison nurse in somatic care departments]. / L'infirmière de psychiatrie de liaison dans les services de soins somatiques.

The role of the psychiatric liaison nurse is continuing to develop within somatic wards. Its foundations are based on the recognition of the value accorded to interactions between physical and psychical dimension. This account of a psychiatric liaison nurse's practice at the university hospital of Nantes shows the positive impact a successful collaboration on inpatients.

[Scope of practice of an Advanced Practice Nurse at the Swiss Epilepsy Centre]. / Praxistätigkeit einer Advanced Practice Nurse im Schweizerischen Epilepsie-Zentrum.

Epilepsy is, after stroke, the second most prevalent neurological disease. The disease has a manifold etiology and symptoms and hence treatment options. From the patients who seek treatment in epilepsy centres, some suffer from psychogenic, non-epileptic seizures. Patient with epileptic seizures have to integrate a medication regimen into their lives, accept symptoms and change their life style to seizure preventing habits. Patients with non-epileptic seizures need psychotherapeutic treatment. Care has to be offered over long periods of time and needs to be tailored to very diverse patients' and family situations. Nurses in this field need broad knowledge about the diseases and treatments as well as enhanced skills in counselling and caring for these patients. Therefore the Swiss Epilepsy Centre in Zurich hired an Advanced Practice Nurse (APN) to increase patients' satisfaction with care and enhance nurses' skills and knowledge. This article analyses the work content of the advanced practice nurse and describes first experiences one year after the implementation of an APN-role. The APN worked half of her time in direct patient and family care. The rest of her work load concerned practice development in coaching and educating the nursing staff, being involved in projects and collaborating with the head nurse on specific topics. In conclusion, implementation of an advanced practice nurse has been shown to be beneficial since patients' feedback were very positive and the increase in nurses' skills and competencies has been assessed as noticeable.

[The difficulties in assessing pain in mental health]. / Les difficultés de l'évaluation de la douleur en santé mentale.

Understand pain in mental health a model which integrates biological, psychological and socio-cultural factors is called for. Due to the psychiatric dimension, the perception of pain in patients, in particular for those suffering from schizophrenia, is complex. The assessment of pain is imperative. In order to take into account pain in patients suffering from psychiatric disorders, improvement in the initial training of healthcare workers is essential.

[Psychiatric disorders and somatic pathologies]. / Les troubles psychiatriques et les pathologies somatiques.

Over recent decades significant advances have been made in the treatment of patients with serious psychiatric illnesses such as schizophrenia or mood disorders. These advances result from the use of new molecules and especially biopsychosocial treatments drawing on multidisciplinarity and networking. Supporting the somatic treatment of patients is one of the major challenges for improving psychiatric care.

[Dermatological diseases in psychiatry]. / Les troubles dermatologiques en psychiatrie.

From Ekbom's syndrome to neurotic acne, from seborrheic dermatitis to psoriasis or rosacea, without forgetting atopic dermatitis in children, these dermatological illnesses all have a direct or indirect link with psychiatric pathology In the field of dermatological infections, treatment must be provided by both the dermatologist and psychiatrist. The skin is an interface, attacked by external factors, as well as expressing psychic conflicts. In this context, there is a real place for psychodermatology.

[Pedicures and podiatry in psychiatry and social insecurity]. / La pédicurie podologie en psychiatrie et la précarité sociale.

Practicing pedicures and podiatry in a psychiatric environment is a particular speciality. This specificity arises not only from the disorders and complications encountered, but also from the connection established between the patient and the healthcare worker during treatment.