Urinary enzyme excretion and changes in renal functions induced by toxic substances or by renal ischemia in rats.

The urinary excretion of four enzymes (alkaline phosphatase: AP, leucine aminopeptidase: LAP, lactate dehydrogenase: LDH, muramidase: M) was measured in unanesthetized adult male Wistar rats within 48 h after either a single injection of mercuric chloride (HgCl2) (0.5-1.0 mg x kg-1), or of gentamicin (2.5-25 mg x kg-1), or of tobramoycin (2.5-25 mg x kg-1), or after 30 min of clamping of both renal arteries. Glomerular filtration rate (GFR), TmPAH, plasma urea, urinary protein and sodium excretion were measured simultaneously. The excretion of AP, LAP and LDH, but not that of M, increased significantly above control levels after renal ischemia or the nephrotoxic agents; the increase was dose-related after HgCl2. GFR was not depressed, but TmPAH decreased after the higher doses of the toxic agents. Though more sensitive for detecting minor grades of acute renal damage than function tests, measurements of urinary enzyme excretion were fraught with large inter-individual variation, and variable time-course of changes in different types of renal damage. Short-term exposure (3 months) to phenylmercuric acetate was associated with a significant decrease of the urinary excretion of AP, and of LAP, and of AP activity measured histochemically in proximal tubular cells.

[Chronicity: chronicization or chronification? Or, the disease evolution in relation to therapy]. / Chronicité: chronicisation ou chronification? Ou de l'évolution morbide à la relation thérapeutique.

The state of chronicity in the psychiatric patient questions the psychiatrist's sense of responsibility as well as his guilt feelings due to therapeutic failure. On the other hand, chronicity revives the psychiatrist's curiosity and interest in discovering more affective means to counteract a process which seems, apparently, inevitable. The author, after demonstrating that chronicity cannot be defined in accordance with psychiatric nosology, not simply in opposition to an acute state, proposes a definition that takes into account the process as one developing in the interaction between the patient, his environment and his therapist. This long and morbid evolution, which we call chronicity, corresponds to the patient's existential equilibration which is characterized by dependency and ruptures with his personal history, where the perception of time is altered and where all desires are given up. The true representative of this state can thus be perceived only through the relationships that are established. The author therefore defines this evolution as a process developing in the interaction with a given environment (hospital or other), and/or the therapeutic relationship. It becomes thus necessary to question the structures that generate chronicity, whether it be the hospital, the social services which might foster child-like dependance, chemotherapy, or negative attitudes resulting from a therapeutic relationship. A more adequate healing attitude permits a modification of the precarious compromises which the patient tends to establish, and serves to encourage his possibilities to gain more freedom of action.

[Institutional therapy. Psychiatry and penitentiary problems. Introduction]. / Thérapies institutionnelles. Psychiatrie et problèmes pénitentiaires. Introduction.

The author relates the history of the institutional therapies which have been developed, mainly since 1929, by Hermann Simon. This avant-garde psychiatrist has not only developed the occupational therapies but he has also recommended both the liberalization of the institution and the constant analysis of its problems. The institutional therapies have the tendency, nowadays, to increase infinitely but their choice is not always logically motivated and their use risks being not very useful, if it is not determined by a clear therapeutic plan regarding the patient and by a well defined therapeutic attitude in the institution. The author introduces then the second subject of the discussion: "Psychiatry and penitentiary problems" by recalling the difficulties of the modern psychiatry to abandon its origins and to get rid of the asylum ghetto. This is probably the reason why most of the psychiatrists elude the psychological and psychiatric problems presented in prison and why they avoid every collaboration with the judicial and administrative authorities. Delicate situations, which call the psychiatrists into question by posing them problems of freedom, human rights, justice and social demands.

[Continuing Education Course of the Swiss Society for Psychiatry. Biological aspects of psychiatry. Introduction]. / Fortbildungskurs der Schweizerischen Gesellschaft für Psychiatrie. Biologische Aspekte der Psychiatrie. Eröffnung.

The author traces the prestigious history of the Burghölzli, cradle of Swiss psychiatry. He also describes the outstanding role played by Zurich as the city in which integration took place between the developing psychiatry, psycho-analysis, psychodynamics and biological research. The author shows how psychiatry, which had been faced with the mechanistric and philosophical dilemma of an epoch, could disengage from the dangers of a reductive approach thanks to Freud's influence, as well as the knowledge produced by biological and psychopathological discoveries. A new equilibration was, thus, found and a multidimensional model came into being. Today psychiatrists may choose to become either clinicians, or psychoanalysts, or devote themselves to research. Contract has become essential as well as the recognition of these different domains, this in order to improve the understanding of mental disorder.

[Social psychiatry]. / Le psychiatre de/dans la société.

The author attempts an analysis of some of the socio-cultural elements which have marked the birth of (modern?) psychiatry and which have consequently influenced the education, identity and ethical values of the practitioner who choses to become a psychiatrist. The author draws attention to the problem of the psychiatrist's autonomy by stressing the important relationship between autonomy (or lack of autonomy) and the dominant political ideologies. Such relationship appears more clearly when the psychiatrist uncritically accepts to become "the psychiatric expert" in criminal and civil law, suicide, sex, death, etc., in other words, whenever accepting the role of "managerial technician". It is evident that the psychiatrist cannot renounce the social responsibilities which fall upon him because of his understanding and analysis of human behaviour, but it is also evident that a redefinition of the psychiatrist's role in society is called for. Such a re-definition will be possible only by the permanent exercise of self-criticism, honesty towards oneself, moral integrity and the capacity to differentiate between true autonomy and the illusion of autonomy when operating in the name of an official psychiatry which is often also a vehicle for the enforcement of a political ideology.

[The psychiatrist and stress, or the psychiatrist's stress...]. / Le psychiatre et le stress, ou le stress chez le psychiatre...

Today's popular image of the psychiatrist is often that of a specialist capable of analysing, with a sort of bewildering power, all of his patients's reactions and psychological problems. The patient's capacity to unfold appears to increase almost as a result of the psychiatrist's control over his own emotions. The author, who is here referring to Epinal's image of the infallible psychiatrist, believes that the psychiatrist, in moments of privacy can observe the effects of his own emotional stress and how they often relate to his unresolved neurotic problems. It is in his practice, nevertheless, that the psychiatrist can privilege and give meaning to his own emotional stress in order to gain deeper insight in his mode of relating to his patient. Such additional awarness should then permit a more careful and satisfying analysis of what is experienced in a two person or group relationship. The acknowledgment of physical state resulting from emotional stress precedes an insight which always corresponds to a signifier leading to a signified which is then to be decoded.