The transition of care from fertility specialists to obstetricians: maternal adjustment and postpartum depressive symptoms.

AIM: This study examines the transition from fertility to obstetrical care of women who conceived through IVF. MATERIALS & METHODS: 33 women filled out questionnaires before IVF, during pregnancy and after birth on infertility stress, maternal adjustment and depressive symptoms. During pregnancy, they participated in an interview about their emotional experiences regarding the transition. Responses were sorted into three categories: Autonomy, Dependence and Avoidance. RESULTS: Exploratory results show that 51.5% of women had no difficulties making the transition (Autonomy), 21.2% had become dependent (Dependence) and 27.3% had distanced themselves from the specialists (Avoidance). Women who became dependent had more trouble adjusting to motherhood and more depressive symptoms. CONCLUSION: Difficulty making the transition may be linked to decreased ability to adjust to motherhood and more postpartum depressive symptoms.

[Hegemonic model of autism: epistemological crossroads between medicine, family and politics]. / Hégémonie du modèle de l'autisme: carrefour epistémologique entre médecine, familles et politique.

The aim of this article is to make a contribution to the regional reflection with regard to autism spectrum disorders (ASDs) at a key moment in which the authorities are requested by the users, professionals in the fields of health, pedagogy and education to put forward a structured answer to a multitude of expressed needs. The question for the creation of a competence pole of an academic tertiary level is posed in order to advise in the best possible way the families who do not know how to orient themselves in the maze and contradictions of the proposed solutions and to help the professionals who are submerged by an ever increasing demand of services exceeding the means of the existing institutions and who cannot justify their choices among the various existing theoretical and scientific models.

[Psychiatry]. / Psychiatrie.

The novelties in clinical psychiatry are close to somatic medicine adaptation. The clinical staging concept in psychiatry (as in cancerology) is the result of an early intervention strategy in psychotic disorders. A differentiated mode of understanding of the phases of psychiatric disorders allows a prevention oriented approach. Individualized therapeutic programmes in accordance with specific problematics favors the orientation towards focalised follow-ups, for instance CBT programmes on Internet may be proposed to patients motivated and rather autonomous. Others, on the contrary, less accessible to health care should benefit of the support of a mobile team and specific coaching to return to vocational services. Systematic follow-up of the metabolic syndrome, often induced by atypical antipsychotics, belongs to those basic adjustment processes.

The PsyCoLaus study: methodology and characteristics of the sample of a population-based survey on psychiatric disorders and their association with genetic and cardiovascular risk factors.

BACKGROUND: The Psychiatric arm of the population-based CoLaus study (PsyCoLaus) is designed to: 1) establish the prevalence of threshold and subthreshold psychiatric syndromes in the 35 to 66 year-old population of the city of Lausanne (Switzerland); 2) test the validity of postulated definitions for subthreshold mood and anxiety syndromes; 3) determine the associations between psychiatric disorders, personality traits and cardiovascular diseases (CVD), 4) identify genetic variants that can modify the risk for psychiatric disorders and determine whether genetic risk factors are shared between psychiatric disorders and CVD. This paper presents the method as well as sociodemographic and somatic characteristics of the sample. METHODS: All 35 to 66 year-old persons previously selected for the population-based CoLaus survey on risk factors for CVD were asked to participate in a substudy assessing psychiatric conditions. This investigation included the Diagnostic Interview for Genetic Studies to elicit diagnostic criteria for threshold disorders according to DSM-IV and algorithmically defined subthreshold syndromes. Complementary information was collected on potential risk and protective factors for psychiatric disorders, migraine and on the morbidity of first-degree relatives, whereas the collection of DNA and plasma samples was already part of the original CoLaus survey. RESULTS: A total of 3,691 individuals completed the psychiatric evaluation (67% participation). The gender distribution of the sample did not differ significantly from that of the general population in the same age range. Although the youngest 5-year band of the cohort was underrepresented and the oldest 5-year band overrepresented, participants of PsyCoLaus and individuals who refused to participate revealed comparable scores on the General Health Questionnaire, a self-rating instrument completed at the somatic exam. CONCLUSION: Despite limitations resulting from the relatively low participation in the context of a comprehensive and time-consuming investigation, the PsyCoLaus study should significantly contribute to the current understanding of psychiatric disorders and comorbid somatic conditions by: 1) establishing the clinical relevance of specific psychiatric syndromes below the DSM-IV threshold; 2) determining comorbidity between risk factors for CVD and psychiatric disorders; 3) assessing genetic variants associated with common psychiatric disorders and 4) identifying DNA markers shared between CVD and psychiatric disorders.

[Stress in health care workers]. / Le stress du soignant ou comment se soigner soi-même.

A growing body of evidence indicates that health care professionals are in need of support. Beside heavy clinical patient volume or administrative duties, stress related to the significance of contextual factors is an important source of clinician's distress. Identification of and working through such stress can be a durable source of support. This article discusses key elements of these stressors, namely, the role of emotions of the clinician, awareness of limits, confusion about empathy, the influence of development and life trajectory on professional identity and the conflicting roles of the health care provider being in need of support.

[Psychological support of cancer patients in the oncological consultation]. / Le soutien psychologique du patient cancéreux en clinique oncologique.

Due to its life threatening character, a cancer diagnosis represents an existential rupture, disturbing an individual's life trajectory perceived beforehand as a continuum. As a consequence, a patient's physical, psychological, social and spiritual equilibrium may be disturbed, calling for a support by clinicians, which surpasses biomedical treatment. A key element of support relies on patient-centered communication, which not only demands technical skills, but also a reflective approach on interpersonal factors which shape the relationship, on the choice and the idealized representation of the clinician's profession as well as its limits. This article summarizes main aspects of patient-physician communication and our experience as teachers of the so-called Communication Skills Training. It provides a review on research in progress in this field and finally indicates other elements of support, which contribute to the << narrative reconstruction >> of the patient facing the rupture induced by cancer.

[The general practitioner and the psychiatrist: a failure or a success?]. / Le genéraliste et le psychiatre: echec ou réussite?

The authors present the conclusions of a workshop which was organised in the framework of the annual congress of the Swiss General Practitioners Society which focused on the collaboration between primary care practitioners (MPR) and psychiatrists in the framework of the mental health care network. These few ideas resulting from a sort of focus group of MPR, animated by a general internal medicine practitioner and a psychiatrist, allow for the exposal of misunderstandings and ambiguities and the insistence on the importance of relational ethics, on role sharing, and the analysis of emotional and defensive motions in order to favour inter-professional cooperation.

Emotional behavior in acute stroke: the Lausanne emotion in stroke study.

OBJECTIVE: To study emotional behaviors in an acute stroke population. BACKGROUND: Alterations in emotional behavior after stroke have been recently recognized, but little attention has been paid to these changes in the very acute phase of stroke. METHODS: Adult patients presenting with acute stroke were prospectively recruited and studied. We validated the Emotional Behavior Index (EBI), a 38-item scale designed to evaluate behavioral aspects of sadness, aggressiveness, disinhibition, adaptation, passivity, indifference, and denial. Clinical, historical, and imaging (computed tomography/magnetic resonance imaging) data were obtained on each subject through our Stroke Registry. Statistical analysis was performed with both univariate and multivariate tests. RESULTS: Of the 254 patients, 40% showed sadness, 49% passivity, 17% aggressiveness, 53% indifference, 76% disinhibition, 18% lack of adaptation, and 44% denial reactions. Several significant correlations were identified. Sadness was correlated with a personal history of alcohol abuse (r = P < 0.037), female gender (r = P < 0.028), and hemorrhagic nature of the stroke (r = P < 0.063). Aggressiveness was correlated with a personal history of depression (r = P < 0.046) and hemorrhage (r = P < 0.06). Denial was correlated with male gender (r = P < 0.035) and hemorrhagic lesions (r = P < 0.05). Emotional behavior did not correlate with either neurologic impairment or lesion localization, but there was an association between hemorrhage and aggressive behavior (P < 0.001), lack of adaptation (r = P < 0.015), indifference (r = P < 0.018), and denial (r = P < 0.045). CONCLUSIONS: Systematic observations of acute emotional behaviors after stroke suggest that emotional alterations are independent of mood and physical status and should be considered as a separate consequence of stroke.

The interpreter's role with immigrant patients: contrasted points of view.

Immigration in Western societies sometimes leads to medical consultations without any shared language between physician and patient. The intervention of a third party is required in such cases. This paper details a study of the role of such a third party. Conducted between 1998 and 2001 in French-speaking Switzerland by physicians and linguists, this research used several techniques of data production. In order to compare the viewpoints of the actors concerned (physicians, patients, and translators), researchers used questionnaires, semi-structured interviews, and focus groups. Analysis of these data reveals that professional translators perceive themselves as active participants who improve communication by bridging the gap between physician and patient. In the translators' perspective, this gap is both linguistic and cultural. On the other hand, most physicians and patients interrogated do not share this view. Points of view about languages can lead to miscommunication in medical settings in spite of a qualified interpreter's presence. This article discusses visions of the interpreter's role, which range from instrument to co-therapist.