[Exercise addiction]. / Addiction à l'exercice.

Exercise addiction, although not yet officially recognized, can be defined as the harmful practice of physical exercise, described as a compulsive need, where damage take precedence over the benefits of this practice, with a continuation of this behavior despite the negative consequences. A number of risk factors have been identified, including psychopathological conditions such as eating disorders or other addictions. It is possible to detect this addiction and assess its intensity using multidimensional questionnaires, even the clinical relevance and thresholds of which are still debated. Despite the absence of validated treatments, motivational approaches and cognitive-behavioural therapies can be useful, combined with nutritional management if necessary, as well as management of concomitant disorders.

L'addiction à l'exercice peut être définie par une pratique compulsive de l'exercice physique, où les dommages prennent le pas sur les bienfaits, avec une poursuite du comportement malgré les conséquences négatives. Certains facteurs de risque individuels, environnementaux, et propres au sport ont été identifiés tels que la recherche d'une amélioration des performances, des troubles du comportement alimentaire, ou d'autres addictions. Il est possible de détecter cette addiction et d'en évaluer l'intensité grâce à des questionnaires dont la pertinence clinique et les seuils sont encore discutés. Malgré l'absence de traitements validés, l'approche motivationnelle et les thérapies cognitives et comportementales peuvent être utiles, associées à une prise en charge nutritionnelle si nécessaire, ainsi que le traitement des troubles concomitants.

[The end of dialysis: the weariness to carry on]. / Médecin et patient face à l'arrêt de la dialyse : la fatigue de continuer.

Voluntary cessation of hemodialysis is a common cause of death in dialysis patients, often occurring related to an alteration in their quality of life. At the same time, psychiatric disorders such as depression or anxiety are common and often underestimated among these patients, that accentuate the suffering and complicate compliance with dialysis. In this paper some psychopathological conditions will be addressed, as well as the question of the patient's ambivalence towards dialysis and the clinical and ethical dilemma of caregivers: respect the patient's choice to stop treatment or keep them alive at all costs? A multidisciplinary approach, including palliative care, is essential to support the reflection and make balanced decisions while respecting patient autonomy.

L'arrêt volontaire de l'hémodialyse est une cause fréquente de décès chez les patients dialysés, survenant souvent en lien avec une détérioration de leur qualité de vie. Parallèlement, les conditions psychiatriques comme la dépression ou l'anxiété sont répandues et souvent sous-estimées chez ces patients, en accentuant la souffrance et en compliquant la compliance à la dialyse. Dans cet article, sont abordées certaines conditions psychopathologiques, ainsi que la question de l'ambivalence du patient face à la dialyse et le dilemme clinique et éthique des soignants: respecter le choix du patient d'arrêter le traitement ou le maintenir en vie à tout prix? Une approche pluridisciplinaire, incluant également les soins palliatifs, est essentielle pour accompagner la réflexion et prendre des décisions pondérées dans le respect de l'autonomie des patients.

One for all, all for one: neuro-HIV multidisciplinary platform for the assessment and management of neurocognitive complaints in people living with HIV.

BACKGROUND: With ageing, comorbidities such as neurocognitive impairment increase among people living with HIV (PLWH). However, addressing its multifactorial nature is time-consuming and logistically demanding. We developed a neuro-HIV clinic able to assess these complaints in 8 h using a multidisciplinary approach. METHODS: People living with HIV with neurocognitive complaints were referred from outpatient clinics to Lausanne University Hospital. Over 8 h participants underwent formal infectious disease, neurological, neuropsychological and psychiatric evaluations, with opt-out magnetic resonance imaging (MRI) and lumbar puncture. A multidisciplinary panel discussion was performed afterwards, with a final report weighing all findings being produced. RESULTS: Between 2011 and 2019, a total of 185 PLWH (median age 54 years) were evaluated. Of these, 37 (27%) had HIV-associated neurocognitive impairment, but they were mainly asymptomatic (24/37, 64.9%). Most participants had non-HIV-associated neurocognitive impairment (NHNCI), and depression was prevalent across all participants (102/185, 79.5%). Executive function was the principal neurocognitive domain affected among both groups (75.5% and 83.8% of participants impaired, respectively). Polyneuropathy was found in 29 (15.7%) participants. Abnormalities in MRI were found in 45/167 participants (26.9%), being more common among NHNCI (35, 77.8%), and HIV-1 RNA viral escape was detected in 16/142 participants (11.2%). Plasma HIV-RNA was detectable in 18.4% out of 185 participants. CONCLUSIONS: Cognitive complaints remain an important problem among PLWH. Individual assessment from a general practitioner or HIV specialist is not enough. Our observations show the many layers of HIV management and suggest that a multidisciplinary approach could be helpful in determining non-HIV causes of NCI. A 1-day evaluation system is beneficial for both participants and referring physicians.

[Borderline psychiatric disorder in the general hospital : specificity and clinical challenges]. / Personnalité borderline à l'hôpital général : spécificités et défis cliniques.

Borderline personality disorder (BPD) is a psychiatric condition frequently encountered at the general hospital. This article will focus on the multiple presentation of this mental illness in the aforementioned setting, such as chronic somatic disease, multiple physical complaints as well as chronic pain, all of which that could severely alter the life quality. In this context, especially if there is an unsatisfied need for reinsurance, risk taking behavior (self-harm or harming others) may arise, as well as significant rise of medical costs through multiple medical consultations, longer average lengths of stay and additional complementary examinations. Through a variety of recommendations and a better understanding of BPD, a therapeutic link can be established to facilitate management.

Le trouble de la personnalité borderline (TPB) est une condition psychopathologique fréquente à l'hôpital général. Dans cet article, nous abordons le spectre des présentations cliniques intrahospitalières, dont les pathologies somatiques chroniques, les plaintes physiques multiples et les douleurs chroniques. L'ensemble de ces conditions impactent lourdement la qualité de vie des patients atteints d'un TPB. Lorsque les besoins de réassurance ne sont pas satisfaits, peuvent apparaître des comportements auto et hétéro-agressifs, ainsi qu'une augmentation des coûts médicaux, via une hausse des consultations, des durées de séjour à l'hôpital somatique et des examens complémentaires. Grâce à diverses recommandations et à une meilleure connaissance du TPB, un lien thérapeutique facilitant la prise en charge peut être établi.

[Psychogenic polydipsia†: a (still) unknown psychosomatic entity]. / Polydipsie psychogène†: une entité somato-psychiatrique (encore) méconnue.

Psychogenic polydipsia, as well referred to as «â€…potomania ¼, is a clinical entity that can be found in psychiatric as well as in physical care settings. Its diagnosis is based on the detection of an excessive fluid intake along with a polyuria, after excluding any potential somatic cause of this clinical presentation. Given the different somatic complications and care complexity, early detection and multidisciplinary interventions are necessary. This article offers a literature review on this topic.

La polydipsie psychogène, également dénommée «â€…potomanie ¼, est une entité clinique que l'on rencontre en milieu psychiatrique, ainsi qu'en milieu somatique. Son diagnostic se base sur la détection d'une consommation excessive d'eau et d'une polyurie, après exclusion de toute cause somatique pouvant être à l'origine du tableau clinique. Vu les diverses complications somatiques et la complexité de la prise en charge, la nécessité de la détection précoce et d'une approche pluridisciplinaire est primordiale. Cet article propose une revue de la littérature scientifique sur ce sujet.

[Doctor, I'm afraid of suffocating! COPD and psychiatric manifestations]. / Docteur, j'ai peur d'étouffer ! BPCO et manifestations psychiatriques.

The chronic obstructive pulmonary disease is a frequent and increasing disease in Western countries. Psychiatric comorbidities, such as depression or anxiety, are often observed and have a major impact on the quality of life and on the prognosis of the patients. Several models based on physiopathological and behavioral psychotherapy researches help us to understand this association between somatic and psychiatric disease. The detection and the treatment of these comorbidities are challenges for the practitioner and make a multidisciplinary approach recommended. This article aims to summarize the current state of the knowledge in this domain and to present to the practitioners the various pharmacological and psychotherapeutic options.

La bronchopneumopathie chronique obstructive est une maladie fréquente et en augmentation dans les pays occidentaux. Fréquemment, les patients atteints souffrent également de comorbidités psychiatriques, telles que la dépression ou l'anxiété, qui ont un impact majeur tant sur leur qualité de vie que sur leur pronostic. Plusieurs modèles reposant à la fois sur des recherches physiopathologiques et psycho-comportementales tentent d'expliquer cette association entre maladie somatique et psychiatrique. La détection et le traitement de ces comorbidités restent un défi pour le praticien et rendent une approche multidisciplinaire souhaitable. Cet article vise à résumer l'état actuel des connaissances dans ce domaine et à présenter aux praticiens les différentes options thérapeutiques tant pharmacologiques que psychothérapeutiques.

[Psychotherapy training for psychiatrists : issues and challenges]. / La formation à la psychothérapie du psychiatre : questions et enjeux.

Since the adoption of the Swiss psychiatrist and psychotherapist double title in 1961, the medical training in psychotherapy must obey specific requirements. In parallel to the clinical practice, the supervisions and the personal experience, 180 hours of theoretical training are required, in each of the psychotherapeutic orientations chosen by the medical doctor (psychodynamic, family / systemic and behavioural and cognitive therapies). Even though the effectiveness of these treatments is well established and there is no significant difference between psychotherapeutic schools in this respect, the choice of an orientation for psychotherapy training requires an adequate pedagogic process, both on the theoretical side, and in the ability to choose a suitable form of psychotherapeutic treatment adapted to the psychiatrist's conversational style.

Depuis l'adoption du double titre de psychiatre et psychothérapeute en 1961, la formation à la psychothérapie du médecin doit obéir à des exigences spécifiques. Parallèlement à la pratique clinique, aux supervisions et à l'expérience personnelle, 180 heures de formation théorique sont exigées, et ceci dans chacun des axes que le médecin peut choisir. Alors même que l'efficacité du traitement psychothérapeutique est bien démontrée et qu'il n'y a pas de différence notable entre les écoles sur ce plan, le choix d'une école de psychothérapie pour la formation nécessite un dispositif pédagogique adéquat, tant sur le plan théorique que dans la possibilité de choisir une forme de traitement adaptée au style conversationnel du médecin.

Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study.

BACKGROUND: Conversion disorder (CD) is no longer a diagnosis of exclusion. The new DSM-V criteria highlight the importance of 'positive signs' on neurological examination. Only few signs have been validated, and little is known about their reliability. OBJECTIVE: The aim was to examine the clinical value of bedside positive signs in the diagnosis of CD presenting with weakness, gait or sensory symptoms by assessing their specificity, sensitivity and their inter-rater reliability. PATIENTS AND METHODS: Standardised video recorded neurological examinations were performed in 20 consecutive patients with CD and 20 'organic' controls. Ten previously validated sensory and motor signs were grouped in a scale. Thirteen additional motor/sensory 'positive signs', 14 gait patterns and 1 general sign were assessed in a pilot validation study. In addition, two blinded independent neurologists rated the video recordings to assess the inter-rater reliability (Cohen's κ) of each sign. RESULTS: A score of ≥ 4/14 on the sensory motor scale showed a 100% specificity (CI 85 to 100) and a 95% sensitivity (CI 85 to 100). Among the additional tested signs, 10 were significantly more frequent in CD than controls. The interobserver agreement was acceptable for 23/38 signs (2 excellent, 10 good, 11 moderate). CONCLUSIONS: Our study confirms that six bedside 'positive signs' are highly specific for CD with good-excellent inter-rater reliability; we propose to consider them as 'highly reliable signs'. In addition 13 signs could be considered as 'reliable signs' and six further signs as 'suggestive signs' while all others should be used with caution until further validation is available.

Psychotherapy of Dependent Personality Disorder: The Relationship of Patient-Therapist Interactions to Outcome.

OBJECTIVE: So far, only a few studies have focused on psychotherapy for Dependent Personality Disorder (DPD). DPD is marked by a repetitive pattern of efforts aiming at maintaining close relationships, which may present as a lack of assertiveness and as a difficulty in making routine decisions. The present study aims at exploring processes of change taking place during the working phase of a clarification-oriented psychotherapy (COP) by focusing on the in-session patient-therapist interaction, as it changes during treatment and their links with treatment outcome. Methods: N = 74 patients with DPD were recruited in a naturalistic setting; they underwent long-term COP. Sessions 15, 20 and 25 were video- or audio-recorded and analyzed using the Process-Content-Relationship Scale, an observer-rated instrument that measures the quality of the interaction processes from patient's and therapist's perspectives. Therapy outcomes were assessed with the Personality Inventory - Dependency Subscale, Beck Depression Inventory, Inventory of Interpersonal Problems and Self-efficacy Scale at intake and discharge of therapy. Three-level Hierarchical Linear Modeling was applied to test the hypotheses. Results: Improvement in interaction processes was observed in all patient's and therapist's variables over the sessions 15, 20, 25. Overall, this increase in quality of interaction process was unrelated with outcome, but decrease in dependency traits was predicted by increase in therapist's quality of relationship offer, understanding of content and directivity over the course of the working phase of COP. Conclusions: Studying interaction processes in DPD provides an initial understanding of differential roles of potential mechanisms of change in effective treatment.