[Care programmes, to respond to the breakdown of care and lack of consent in psychiatry]. / Programmes de soins, pour répondre à la rupture de soins et au défaut de consentement en psychiatrie.

We need to go back to the time of alienist doctors to understand the interest of the care programme established in 2011. In fact, the psychiatric clinic requires professionals to accompany the patient over time, while accepting the variability of suffering. In this context, this system proposes an alternative to full in-patient care while preserving the aspect of compulsory treatments. Caring for the patient, acquiring their consent while preserving their rights is a real challenge for the psychiatrist and their team.

[Preventing violence during hospitalisations in psychiatry]. / Prévenir les moments de violence lors des hospitalisations en psychiatrie.

Over recent years, the psychiatric sector has endeavoured to develop community-based care. Paradoxically, the number of compulsory hospitalisations is increasing. At the same time, the legal framework is evolving and measures relating to the deprivation of liberty in the context of psychiatric care have given rise to extensive guidelines. The work of the French National Health Authority represents, in this context, a certain continuity, with regard to the legal, ethical and social discussions around restriction of liberty practices within psychiatric units. The main focus is on the prevention and management of violent outbursts.

[The latest best practice guidelines relating to seclusion and restraint]. / Les dernières recommandations de bonnes pratiques sur l'isolement et la contention.

Several measures relating to seclusion and restraint are included in the French public health code. The best practice guidelines of the French National Health Authority, published in 2017, define these two notions and advise on the behaviour to adopt with regard to their implementation and monitoring. Likewise, informing and supporting the patient when these measures are lifted are critical moments which the teams must also be able to manage correctly.

Organization of mental health care: the role of general practitioners / Organisation des soins en santé mentale : le rôle des médecins traitants.

Organization of mental health care: the role of general practitioners. In the evaluation of the National French Psychiatry / Mental Health plan 2011-2015, as carried out by the High Public Health Council, some points concern the role of general practitioners and the difficulties they encounter regarding their patients suffering from psychiatric disorders ; are mentioned access to urgent or planned specialized psychiatric care, their role in the management of the physical health of their patients suffering from psychiatric disorders, the vigilance that they must exercise with regard to the over prescription of psychotropic drugs, the announcement of an experiment in the reimbursement of psychotherapies conducted by psychologists and the importance of initial and continuing training of general practitioners in adult and infant-juvenile psychiatry. The regard on psychiatric patients must be changed and the role of general practitioners in this change is important.

Organisation des soins en santé mentale : le rôle des médecins traitants. Dans l'évaluation du Plan psychiatrie santé mentale 2011- 2015, tel qu'il a été réalisé par le Haut Conseil à la santé publique, certains points concernent le rôle des médecins généralistes et les difficultés qu'ils rencontrent concernant leurs patients souffrant de troubles psychiatriques ; sont évoqués l'accès aux soins spécialisés de psychiatrie, urgents ou programmés, leur rôle dans la prise en charge de la santé physique de leurs patients souffrant de troubles psychiatriques, la vigilance qu'ils doivent exercer vis-à-vis de la sur-prescription de psychotropes et l'annonce d'une expérimentation de prise en charge de psychothérapies conduites par des psychologues, ainsi que l'importance d'une formation initiale et continue des médecins généralistes en psychiatrie adulte et infanto-juvénile. Il est nécessaire de changer le regard porté sur les patients psychiatriques et le rôle des médecins générales dans ce changement est important.

[Impairments of empathic process in sexual offenders]. / Les altérations du processus empathique chez les agresseurs sexuels.

The review of literature devoted to empathy deficits of sexual offenders shows that they have difficulties in identifying specific emotions in specific situations. Their perspective taking abilities range from weak to normal. Face to their victims suffering, their emotional replication would be inhibited. Affective and cognitive impairments in sexual offenders do not result from a general empathy deficit but would however result from the context, cognitive distortions or indifference towards victims. Some sexual offenders are able to decenter from themselves and understand their victims' mental states, but maintain their viewpoint, leading them to not identify with their victims or share their feelings. This focus overcomes the common general consideration regarding the lack of empathy among sex offenders by lighting several processes that explain, justify or apologize to them the genesis and persistence of their behavior. It would be interesting to study by using brain imaging techniques the perspective switching mechanisms of sexual offenders.

Personality disorders, but not cancer severity or treatment type, are risk factors for later generalised anxiety disorder and major depressive disorder in non metastatic breast cancer patients.

This study aimed to determine whether personality disorders were associated with later Major Depressive Disorder (MDD) or Generalised Anxiety Disorder (GAD) in breast cancer patients. This longitudinal and multicentric study included 120 French non-metastatic breast cancer patients. After cancer diagnosis (T1) and 7 months after diagnosis (T3), we assessed MDD and GAD (Mini International Neuropsychiatric Interview 5.0). We assessed personality disorders 3 months after diagnosis (VKP). We used multiple logistic regression analysis to determine what were the factors associated with GAD and MDD at T3. At T3, prevalence rate was 10.8% for MDD and 19.2% for GAD. GAD at T3 was significantly and independently associated with GAD at T1 and with existence of a personality disorder, no matter the cluster type. MDD at T3 was significantly and independently associated with MDD at T1 and with the existence of a cluster C personality disorder. Initial cancer severity and the type of treatment used were not associated with GAD or MDD at T3. Breast cancer patients with personality disorders are at higher risk for GAD and MDD at the end of treatment. Patients with GAD should be screened for personality disorders. Specific interventions for patients with personality disorders could prevent psychiatric disorders.

Major depressive disorder, personality disorders, and coping strategies are independent risk factors for lower quality of life in non-metastatic breast cancer patients.

OBJECTIVE: Our aim was to identify risk factors for lower quality of life (QOL) in non-metastatic breast cancer patients. METHODS: Our study included 120 patients from the University Hospital Centers of Tours and Poitiers. This cross-sectional study was conducted 7 months after patients' breast cancer diagnosis and assessed QOL (Quality of Life Questionnaire Core 30 = QLQ-C30), socio-demographic characteristics, coping strategies (Brief-COPE), physiological and biological variables (e.g., initial tumor severity and types of treatment received), the existence of major depressive disorder (Mini International Neuropsychiatric Interview), and pain severity (Questionnaire de Douleur Saint Antoine). We assessed personality disorders 3 months after diagnosis (Vragenlijst voor Kenmerken van de Persoonlijkheid questionnaire). We used multiple linear regression models to determine which factors were associated with physical, emotional, and global QOL. RESULTS: Lower physical QOL was associated with major depressive disorder, younger age, a more severe initial tumor stage, and the use of the behavioral disengagement coping. Lower emotional QOL was associated with major depressive disorder, the existence of a personality disorder, a more severe pain level, higher use of self-blame, and lower use of acceptance coping strategies. Lower global QOL was associated with major depressive disorder, the existence of a personality disorder, a more severe pain level, higher use of self-blame, lower use of positive reframing coping strategies, and an absence of hormone therapy. CONCLUSIONS: Lower QOL scores were more strongly associated with variables related to the individual's premorbid psychological characteristics and the manner in which this individual copes with the cancer (e.g., depression, personality, and coping) than to cancer-related variables (e.g., treatment types and cancer severity). Copyright © 2015 John Wiley & Sons, Ltd.

The new French mental health law regarding psychiatric involuntary treatment.

The French Republic has had four laws governing the detention of people with a mental illness. The first dates from 1838 and remained in place until 1990. The most recent one was issued on 27 September 2013; it confirmed the role of the judge and strengthened the legal procedures. This new French mental health law is an attempt to find a balance between the protection of patients' rights and the need for treatment.

Comorbidity between personality disorders and depressive symptomatology in women: A cross-sectional study of three different transitional life stages.

This study assessed the prevalence of personality disorders (PDs), according to DSM-IV criteria, in relation to depressive symptomatology at three different periods of life in female subjects. Depressive symptoms and personality disorders were assessed in a sample of 568 women from three different transitional stages: 134 students, 314 primiparous women after childbirth and 120 women diagnosed with breast cancer. Depressive symptoms were assessed by the Hospital Depression and Anxiety Scale in the first and third groups and by the Edinburgh Post-natal Depression Scale in the second group, whereas PDs were assessed by the French version of the Vragenlijst voor Kenmerken van de Persoonlijkheid. Depressive symptomatology and rates of PD (20.4% and 6.3%) were equivalent in the three groups. The prevalence of PD was higher in the depressed group compared with the non-depressed group, with more paranoid, borderline, avoidant, obsessive-compulsive, schizotypal, antisocial, dependent and histrionic PD. Our findings support the hypothesis that PDs are more frequently associated with depressive symptoms. Borderline and avoidant PDs were more prevalent among young women. All cluster C PD (dependent, avoidant and obsessive-compulsive) co-occurred significantly with depressive symptoms.

Obsessive compulsive disorder in a patient with twiddler's syndrome.

Twiddler's or twist syndrome is the twisting of pulse generators around themselves. It may result from mechanical manipulation that can induce the malfunction of the device. In this case, twiddler's syndrome resulted from compulsive checking of the device. The implantable cardioverter-defibrillator (ICD) triggered the development of an obsessive compulsive disorder (OCD). Two invasive procedures were required to replace the ICD. Psychiatric intervention prevented the recurrence of twiddler's syndrome in this patient for more than 2 years. We believe that preimplant psychiatric assessment should be the rule.