[Questioning disruptive disorder with emotional dysregulation]. / Questionner le trouble disruptif avec dysrégulation émotionnelle.

Disruptive Emotional Dysregulation Disorder (DEDD) responds to an increase in diagnoses of clastic crises, reactive depression and bipolarity in children and adolescents. Emerging in the 1990s, EDD has become an issue for practitioners, parents and teachers alike, and has become an integral part of the landscape of paediatric and child psychiatric disorders. Its diagnostic complexity is accentuated by criteria that include persistent and disproportionate outbursts of anger, often confused with other pathologies, especially as diagnostic tools are few and far between. Professionals in the field know little about EDD, preferring to diagnose more familiar disorders.

["Sens et motions": a supportive media therapy in oncology]. / "Sens et motions" : une thérapie médiatisée de support en oncologie.

Art therapy is overused in oncology support care, to the point of appearing as an improved form of animation. In the absence of a clearly defined system, there are few guidelines for practice. Here we propose and describe "Sens et motions", an original, reproducible and assessable approach to cancer care.

[Anorexia nervosa, a familiar and complex pathology]. / L'anorexie mentale, une pathologie familière et complexe.

Anorexia nervosa affects people of all ages, and has the highest mortality rate of all psychiatric disorders, following medical complications inherent in the disease or suicide. Early and appropriate treatment is crucial to prevent the risk of chronic disease, which may affect one in two anorexics. Severe undernutrition linked to a complex psychopathology calls for the necessary theoretical and clinical knowledge on the part of the caregiver, applied to the dynamics of care, ideally conceived in a transdisciplinary way and involving nursing teams.

[Unconditional self-acceptance and self-compassion: another clinic for anorexia nervosa?] / L'acceptation inconditionnelle de soi et l'autocompassion : une autre clinique de l'anorexie mentale ?

People suffering from anorexia have a particular emotional and cognitive profile (altered body and self-perception, emotional dysregulation, perfectionism, obsessive traits), which the disorder can compensate for through emotional distancing strategies. Self-compassion and unconditional self-acceptance have been shown to have therapeutic effects on the barriers to recovery associated with this profile.

[Anorexia nervosa and music therapy]. / Anorexie mentale et musicothérapie.

Supporting people suffering from anorexia nervosa remains a challenge. While traditional treatment focuses more on speech and its emergence for the patient and family, non-medicinal and non-verbal therapies are used more systematically, sometimes as a last resort. Yet, as a non-verbal mediated therapy, music therapy can find a legitimate place and complement all the psychiatric, psychotherapeutic, somatic, dietetic and nursing areas where speech already circulates.

[From morbid obesity to complex obesity: somato-psychic issues]. / De l'obésité morbide à l'obésité complexe : des enjeux somato-psychiques.

Complex obesity is a chronic, multifactorial pathology. These repercussions (respiratory insufficiency, hypoventilation syndrome, cardiac insufficiency, loss of functional autonomy and mobility with a tendency to grabatization, depression, behavioral disorders) directly sustain the disease. Access to care is virtually impossible for them outside specialized obesity centers (CSO) and specialized medical and rehabilitation care (SMR). We need to support healthcare teams by analyzing their practices, including those of expert patients, to ensure that complex obesity is treated with the humanity it requires.

[Psychological support for weight loss]. / L'accompagnement psychologique de la perte de poids.

Psychological support for obese people as part of their health care process seems to be a matter of course. However, it is one of the most poorly relayed components in the field. Exploring and assessing are necessary operations in order to develop an integrative approach to psychological support, involving body-mediated approaches and an optimal helping alliance.

[Obesity, a multifactorial, chronic disease]. / L'obésité, une maladie multifactorielle et chronique.

A pathology of modernity, obesity is developing rapidly in the population, linked to multiple risk factors and somatopsychic disturbances. The healthcare system's responses have been enriched by specialized programs and centers, but we mustn't forget basic clinical pragmatism.

[Chronic obstructive pulmonary disease and music therapy]. / Bronchopneumopathie chronique obstructive et musicothérapie.

Chronic obstructive pulmonary disease with disabling co-morbidities can benefit from music therapy devices that are effective on anxiety, dyspnea, depression and quality of life. This complementary support therapy is easy to implement, in hospital or at home, and allows the patient to take ownership of this self-care.

[Psychological support for long Covid patients during a rehabilitation stay]. / L'accompagnement psychologique de patients Covid long lors d'un séjour de rééducation.

Covid long affects each patient differently. This disorder can occur in people with both severe and mild forms of the disease. It is often a series of symptoms that disrupt different areas of life in a very variable way. These symptoms can change rapidly. Moreover, several symptoms are associated and fluctuate (between aggravation and recovery) during very variable periods, which leads to a mosaic diagnosis and engages the need for multidisciplinary management.

[Chronic obstructive pulmonary disease: somato-psychological dimensions]. / Bronchopneumopathie chronique obstructive : dimensions somato-psychologiques.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and is a poorly understood lung disease. It is accompanied by significant psychological co-morbidities (anxiety, depression, identity and body image disorders) which are under-diagnosed and have an impact on quality of life and the frequency of  re-hospitalization. The management of COPD is multidisciplinary and its role is to prevent complications, relieve symptoms and slow the progression of the disease. Therapeutic education of the patient brings a real added value in this multidisciplinary management.

[Psychological state of Covid-19 patients after resuscitation]. / État psychologique des patients Covid-19 après réanimation.

The epidemic of Covid-19 was characterized, from its beginning, by "emergency". A state of emergency enacted by the state authorities to fight, on one hand, against the pandemic as such and, on the other hand, to manage the influx of patients admitted in intensive care. In this unprecedented context, the suffering of the people goes beyond the emergency situation and persists in forms ranging from a pseudo-banality to the complexity of an insidious evolution.

Clinical condition, Resuscitation and Medical-Psychological Care of Severe COVID-19 patients (part 2).

Respiratory rehabilitation is the penultimate step in the medical management of patients with severe COPD-19. It is an essential step before patients' returning home, and is usually carried out in specialised Follow-up and Rehabilitation Clinics. When discharged from hospital, patients with post-severe COVID-19 usually progress in their medical condition. However, they may remain frail and have a constant fear of possible deterioration leading to (re)hospitalisation and a return to baseline. Psychological support in this phase can reduce patients' anxiety and increase their motivation to carry out daily rehabilitation activities. This support provides a stable and consistent basis for patients to focus on their progress, leaving the difficulties behind. Being aware of the improvements in their physical condition allows them to maintain their motivation to continue to be physically active. Psychological support during respiratory rehabilitation aims at preparing patients to return to the normal life they had before the disease. It is usually based on brief psychotherapies that focus on strengthening the patient's abilities through behavioural changes and through reducing risk behaviours. Only after this phase is it sometimes possible to deal with complex issues and to cope with personality mechanisms and maladaptive behaviour patterns.

La réadaptation respiratoire constitue l'avant-dernier étage dans la prise en charge des patients COVID-19 sévère, une étape essentielle avant de retrouver leur vie quotidienne. L'accompagnement psychologique occupe une place importante dans cette étape. Cette réadaptation s'effectue habituellement dans une clinique de Soins de Suite et de Réadaptation (SSR) spécialisée. On peut généralement affirmer que les patients post-COVID-19 sévère sortis de danger vont progresser. Cette progression peut se décrire à travers le modèle de la spirale ascendante. Ce sont, néanmoins, des patients fragiles, pour lesquels on craint perpétuellement une dégradation rapide des paramètres physiologiques qui risque de les ramener vers une (ré)hospitalisation d'urgence et un retour vers la case de départ. L'accompagnement psychologique empêche les sensations négatives d'occuper le devant de la scène et d'aspirer le patient vers le bas. Il permet de baisser les angoisses et d'augmenter les motivations pour effectuer des activités de réadaptation quotidiennes. De cette manière, cet accompagnement a des retentissements physiologiques importants, permettant aux patients de progresser en voie de guérison, malgré certaines séquelles occasionnées par la maladie. Cet accompagnement psychologique permet, également, de préparer les patients à leur retour à la vie d'avant et d'adoucir l'impact traumatisant des souvenirs douloureux. Le patient peut les regarder de nouveau et leur redonner un sens moins troublant. Le travail psychologique vise à rassurer ces personnes qui ont perdu confiance en leur corps. On tend à favoriser des thérapies brèves qui mettent l'accent sur les renforcements des capacités, sur les changements comportementaux et le sevrage des produits, avant d'agir sur les mécanismes de coping et sur les schémas inadaptés plus profonds.

Clinical condition, resuscitation and medical-psychological care of severe COVID-19 patients (part 1).

This interview covers the clinical and psychological condition of patients afflicted with severe COVID-19 and their pulmonary rehabilitation process. For these patients, symptoms are medically urgent and life-threatening. The sequelae of this viral attack and immune response to it are significant, and often persist for months after discharge from intensive care. To understand the medical and psychological state of these patients, a description is given of the organs affected, the oxygen cycle in the body and the medical care procedures that are used to help patients with dysfunctional respiratory systems. The link between physical and psychological progress is described. Physical weakness results from pulmonary sequelae and deconditioning, and is often experienced by patients as mental fatigue similar to psychological depression. This may draw the patient into a downward spiral, with multiple health aspects deteriorating, independently of the resolution of initial problems. Conversely, a positive physical or psychological evolution may lead to the evolution of the other. Thus, reversing the negative trend for just one system component can delay, completely arrest the spiralling down, or transform it into an upward spiral, improving the patient's condition. In addition, for people undergoing severe COVID-19, the return to normal life could be destabilizing and memories that arise from their crisis state may trigger Post-Traumatic Stress Disorder (PTSD). Health and psychosocial professionals hold an important role both in post-hospital care and in secondary prevention, i.e. prevention of relapse and re-hospitalization. Physical rehabilitation work must take these psychological factors into account, in the same way that any psychological follow-up is supposed to consider physiological factors.

Cet entretien porte sur l'état clinique médicopsychologique des patients atteints de COVID-19 sévère et sur leur réadaptation respiratoire. Pour ces patients, les séquelles de l'attaque virale et de la réaction immunitaire sont importantes et apparentes dans les tests fonctionnels et les imageries médicales. Elles persistent souvent quelques mois après la sortie des soins intensifs. Le virus SARS-CoV-2 provoque des atteintes des muqueuses bronchiques et alvéolaires. Le circuit de l'oxygène dans le corps peut être découpé en trois maillons imbriqués: l'ensemble de l'appareil respiratoire, le système cardiovasculaire, les muscles et le métabolisme énergétique. Ces systèmes fonctionnent en interdépendance. Lorsqu'il y a une défaillance de l'un des éléments, les autres sont touchés, pouvant amener l'ensemble à une décompensation. La décompensation respiratoire désigne la défaillance ou l'incapacité du système à fonctionner. Les patients sont hospitalisés en réanimation et bénéficient d'une supplémentation en oxygène, d'un support ventilatoire pour compenser la fatigue des muscles respiratoires et d'un traitement médicamenteux visant à réduire les symptômes et à lutter contre les infections acquises. À la sortie de l'hospitalisation, les patients post-COVID-19 sévère se trouvent dans un état physique et psychologique fébrile. La sensation vécue par ces personnes est celle d'une fatigue physique et mentale ; autrement dit, l'incapacité de trouver des ressources suffisantes pour effectuer des activités simples. Cette fatigue est vécue comme une dépression, une sensation qui elle seule risque d'aspirer le patient dans une spirale descendante : soit d'une fatigue en une absence de motivation, puis de sédentarité en déconditionnement musculaire. Ainsi, il y a un lien étroit qui existe entre progrès physique et renforcement psychologique, les deux sont interdépendants, un déclin dans l'un risque d'entraîner l'autre, mais, à l'inverse, une évolution positive dans l'un fait évoluer l'autre. Se rendre compte de l'amélioration de l'état physique permet de nourrir sa motivation et de trouver de l'énergie permettant de continuer à être physiquement actif. Le travail de réadaptation physique doit tenir compte de ces facteurs psychologiques, de la même manière que tout suivi psychologique doit tenir compte des facteurs physiologiques. Pour les personnes subissant un COVID-19 sévère, le retour à la vie normale peut être déstabilisant et les souvenirs de leur état de crise peuvent déclencher un syndrome de stress post-traumatique (SSPT). Les professionnels de la santé et les psychologues jouent un rôle important dans les soins post-hospitaliers et dans la prévention secondaire, c'est-à-dire la prévention des rechutes et des ré-hospitalisations.

[Pulmonary rehabilitation, return home: the issues of psychic care for severe Covid-19 patients]. / Réadaptation pulmonaire, retour au domicile : les enjeux du soin psychique des patients Covid-19 sévère.

Upon discharge from the ICU, most severe post-Covid-19 patients are considered out of danger and on the mend. A large proportion of these patients are able to go home, but some continue to be frail and suffer from the side effects of the disease and the past heavy hospitalization. Others do not have the necessary support at home. Pulmonary rehabilitation is becoming a critical step in prognosis and a comfortable return home. It allows many patients to regain confidence in their body and its potential, to bridge the gap between a medically safe passive position and daily life, which should become as independent as possible, and to optimally reduce the risks of regression or relapse.

[Depression and music therapy: the receptive composite montage with a projective focus]. / Dépression et musicothérapie : le montage composite réceptif à visée projective.

Depression is a frequent mood disorder that requires a consensual therapeutic arsenal combining psychotropic drugs and psychotherapies. When depression requires hospitalization, particularly in the context of a major depressive disorder, having an integrative tool that induces a state of relaxation, positive mood and anticipation within twenty minutes is useful for patients and care teams. The Receptive Projective Composite Montage is a standardized music therapy device with evaluated effectiveness that can fulfill this role.

[Prematurity and music therapy: harmonic encounters?] / Prématurité et musicothérapie : rencontres harmoniques ?

Premature birth can cause complications of varying nature and intensity in the child's development. The developmental care given to babies born prematurely is of major importance to their physical and psychological development. After clinical assessment, music therapy can be integrated into this care. It is a source of observed benefits.

[Orthorexia: News and treatment of a modern-day pathology]. / L'orthorexie : actualité et soins d'une pathologie de la modernité.

Contrary to the objective sought by orthorexics, orthorexia ends up affecting health more or less seriously. For these subjects, who are often asocial eaters in search of the perfect food, the obsession with healthy eating becomes unhealthy. Between psychopathology and certain modern eating incentives, this still relatively unknown disorder must be detected, evaluated and treated in order to prevent its harmful consequences.

Self-defining memories in female patients with anorexia nervosa.

OBJECTIVE: Overgeneral autobiographical memory (AM) was reported in patients with anorexia nervosa (AN) using AM cueing tasks that did not directly indexes memories that are personally important to the individual, that is, self-defining memories (SDMs). The aim of this study is to investigate characteristics of SDMs in females with AN. METHOD: A total of 46 outpatients with chronic AN and 52 healthy controls (HC) were asked to recall three SDMs. RESULTS: Compared to HC, patients with AN presented less specific SDMs, but have preserved ability to give meaning to their memories. Patients' SDMs were associated with more negative emotions, more tension (i.e. explicit expression of discomfort, disagreement or unease) and more contamination (i.e. transformation in the memory narrative from a positive to a negative affective state). Content of SDMs differed between patients with AN and HC. Finally, no difference was found in SDMs characteristics between the two subtypes of anorexia nervosa (restricting type and binge eating / purging type). DISCUSSION: Patients with AN recalled overgeneral SDMs with negative content and emotions. In this context, a clinical intervention based on SDMs together with cognitive and emotional remedial therapies could help patients with AN to improve emotion processing and redefine their identity in a more positive way.