Professional occupation after cochlear implantation.

The aims of this study were to verify whether cochlear implants helped profoundly deaf adults to maintain or even to develop their professional occupations, and to identify other elements that may contribute to or, on the contrary, impede such patients' professional success. All adult patients received a questionnaire concerning their professional activities before and after implantation. Demographic data, health information, hearing performance and degree of satisfaction with the implant were also considered. Sixty-seven adults had been implanted, with three different devices, since 1985. At the time of implantation, 34 had been professionally active. After implantation, 29 had remained professionally active, four of whom reported positive developments in their careers. Five patients had become professionally inactive. Those patients who had previously been professionally inactive remained so. There had been no difference in performance, either between different types of cochlear implants or between professionally active or inactive patients. The implanted patients had kept their jobs and many of them had developed their professional skills. In spite of this, cochlear implants may still be perceived as proving insufficiently satisfactory hearing to enable professionally inactive patients to reintegrate and to facilitate further learning or career developments.

Quality of life of patients under home mechanical ventilation for restrictive lung diseases: a comparative evaluation with COPD patients.

The aim of this study was to compare the quality of life of patients under home mechanical ventilation (HMV) for restrictive lung disease, with the quality of life of patients with chronic obstructive pulmonary disease (COPD), having similar decrease in forced expiratory volume in one second (FEV1), but not receiving HMV. Sixteen patients who were receiving intermittent HMV (six post-tuberculosis, four post-poliomyelitis, two neuromuscular diseases, two kyphoscoliosis, two obesity-hypoventilation syndromes) were compared to 15 COPD patients who were receiving only usual conservative treatment, including long-term oxygen therapy. Dyspnoea scores, anxiety, depression, and psychosocial scores, as well as a panel of functional parameters were measured. The two groups did not differ in terms of functional impairment. However, patients under HMV had much better scores for anxiety, depression, and adjustment to illness than COPD patients. Scores for dyspnoea at rest were also better in the HMV group, but showed no relationship to quality of life. In spite of a cumbersome and intrusive type of treatment, patients under home mechanical ventilation for predominantly restrictive lung disease were found to have a better quality of life than chronic obstructive pulmonary disease patients under conservative therapy. In the first group, a longer history of coping with a chronic disease and the perception that medical intervention is effective may in part account for this difference.

[Psychogenic spastic hand]. / La main spastique psychogène.

Twelve patients seen over a 8-year period with psychogenic spasms of the hand are reported. Six elderly patients presented with extrinsic flexion of the two or three medial fingers with sparing of the thumb and index. Six other patients had various hand attitudes following coincidental but not causal trauma to the upper extremity. Because of the differences in clinical presentation, age of patients and coincident trauma in some cases, the former patients were characterized as type I psychogenic spasms and the latter as type II. A major recurrent depression was the commonest psychiatric diagnosis (DSM-III-R, Axis I) with a concurrent dependent or borderline personality (DSM-III-R, Axis II). The diagnosis of psychogenic spasm of the hand is a diagnosis of exclusion, that requires a multidisciplinary approach including surgeon, neurologist, psychiatrist and rehabilitation therapist. Electromyographic studies are used to rule out a neurological or muscular etiology of the condition. Surgical treatment was uniformly unsuccessful and is probably contraindicated. Only one patient had a nearly complete spontaneous recovery.

First field trials with a portable CIS processor for the Ineraid multichannel cochlear implant.

The continuous interleaved sampling (CIS) strategy is a promising sound processing strategy for multichannel cochlear implants which provides immediate improvements in speech recognition when tested on Ineraid users: patients with only a few hours of experience (in laboratory testing) with the CIS strategy score better than with the Ineraid prosthesis they used since they, were implanted. The goal of this study was to evaluate the benefits that can be gained by the use of the new strategy in every day life. Two patients, implanted with the Ineraid multichannel cochlear implant, were equipped with a portable numerical processor programmed to implement a high rate CIS strategy. Their speech recognition was evaluated periodically with consonant and vowel identification tests for more than 6 months of use. Tests were also made with the Ineraid processor during the same experimental sessions and patients were regularly interviewed about their experience. Performance with the portable CIS processor was superior or equal to that obtained previously in the laboratory with the same strategy. Both patients achieved the best scores in 6 years of cochlear implant use. Qualitative reports from the patients suggest that the CIS strategy can improve "hearing" performance of cochlear implant users in many important situations of every day life. Altogether, these results hold great promises for all users of the Ineraid multichannel cochlear implant.

Psychological adaptations and emotional observations of eight multichannel cochlear implant patients.

A pilot study was performed with 8 deaf patients who received the 'Ineraid' multichannel cochlear implant in Geneva, Switzerland. The mechanisms of psychological adaptation in these patients are summarized.

[What is a psychiatric emergency? Elements of a catamnestic and comprehensive approach]. / Qu'est-ce qu'une urgence psychiatrique? Eléments d'une approche catamnestique et compréhensive.

The authors introduce in this paper the first results of a catamnestic research performed in 1980 through interviews on 759 psychiatric emergencies in 1978 at the Saint-Luc clinics (Woluwe). A detailed analysis of psychiatric emergencies confronts the researcher to various problems (how and why is the psychiatrist called?) and more philosophically about mental health, therapeutic efficacy or the objectivity of the analysis. The authors also emphasize deontological problems in this type of research and the image of psychiatry and psychic disarray in the practice of emergency. Furthermore, this research brings up various working accommodations. Finally, the authors indicate some future areas of action, in the specific frame of the studied clinic, in order to ameliorate alternatives to hospitalisation in face of a psychiatric emergency.