[Addictions in the elderly: the viewpoint of an IPA working in EMPSA]. / Les addictions chez le sujet âgé : regard d'une IPA exerçant en EMPSA.

Many elderly people live well and at home, but some require somatic and psychiatric care. Mobile psychiatric teams for the elderly are called upon to intervene with people aged 65-70 and over who are experiencing psychological distress. Among senior citizens, addictive disorders are very common, and are associated with psychiatric and geriatric co-morbidities. Alcohol, tobacco and benzodiazepine use disorders require holistic, individualized care, based on identification, prevention and referral, as well as training and coordination of professionals and caregivers.

[Republication of: Evaluation of the implementation of the 2021 guidelines of the European Society of Cardiology for heart failure with reduced ejection fraction in patients aged over 75]. / Republication de : Évaluation de la mise en application des recommandations 2021 de la Société Européenne de Cardiologie pour l'insuffisance cardiaque à fraction d'éjection réduite chez les patients âgés de plus de 75 ans.

INTRODUCTION: Heart failure is a frequent pathology with a poor prognosis which mainly concerns elderly patients. The recommandations concerning the pharmagical treatment in heart failure with LVEF are reduced on randomized trials carried out on a young population. The aim of this work is to evaluate their application on a population aged ≥ 75. MATERIALS AND METHODS: This is a retrospective, bicentric cohort, concerning patients hospitalized between September 1, 2021 and March 31, 2023, at the hospital centers of Troyes and Romilly sur Seine. The primary endpoint was a composite endpoint combining rehospitalisation rate or all-cause death rate at 6 months. RESULTS: A group of 81 patients was included in the study. The average number of treatments is associated with a significant reduction in the rate of hospitalisations ord deaths at 6 months (p = 0,005); as it concerns the level of titration, the analysing comparing the "therapeutic inertia" group and the "current titration/maximum tolerated dose" group did not reveal any significant difference (p = 0,169). CONCLUSION: Our study highlighted the potential positive impact of the application of the latest ESC recommendations concerning first-line drug treatment on the rate of rehospitalisation or death from all causes, in patients with heart failure reduced LVEF aged over 75.

[Heart failure treatments]. / Les traitements de l'insuffisance cardiaque.

Heart failure is a frequent pathology in the elderly. In particular, it is responsible for many hospitalizations. A distinction is made between chronic and acute forms of heart failure. The management of these forms of heart failure is well established, with treatment recommendations that are regularly updated on the basis of new studies.

[Study of the links between type 2 diabetes and geriatric criteria]. / Étude des liens entre diabète de type 2 et critères gériatriques.

Type 2 diabetes in the elderly remains a major concern for all healthcare professionals and is itself considered a "global pandemic". Its prevalence is high and will continue to increase in years to come, becoming more and more prevalent in the elderly and very elderly. We offer a general summary of the work focusing on the links between type 2 diabetes and geriatric criteria.

[Proper use of oral anticoagulants in the elderly patient]. / Le bon usage des anticoagulants oraux chez le patient âgé.

Direct oral anticoagulants (DOACs) are tending to supplant antivitamin K inhibitors (VKAs) in their common indications, dominated in elderly patients by atrial fibrillation and venous thromboembolism. Nevertheless, it remains necessary to know how best to use VKAs for which there are still indications. It is also important not to assume that AODs can be prescribed without risk, while ignoring certain particularities in their handling, particularly in the most fragile patients with co-morbidities and multiple medications.

[Antidiabetic treatments for the elderly]. / Les traitements antidiabétiques chez le sujet âgé.

Diabetes is very common in people over 75. A broad arsenal of treatments is now available. It is important, however, to choose the right treatment regimen to suit the patient's specific glycemic targets.

[Evaluation of the implementation of the 2021 guidelines of the European Society of Cardiology for heart failure with reduced ejection fraction in patients aged over 75]. / Évaluation de la mise en application des recommandations 2021 de la Société Européenne de Cardiologie pour l'insuffisance cardiaque à fraction d'éjection réduite chez les patients âgés de plus de 75 ans.

INTRODUCTION: Heart failure is a frequent pathology with a poor prognosis which mainly concerns elderly patients. The recommandations concerning the pharmagical treatment in heart failure with LVEF are reduced on randomized trials carried out on a young population. The aim of this work is to evaluate their application on a population aged ≥ 75. MATERIALS AND METHODS: This is a retrospective, bicentric cohort, concerning patients hospitalized between September 1, 2021 and March 31, 2023, at the hospital centers of Troyes and Romilly sur Seine. The primary endpoint was a composite endpoint combining rehospitalisation rate or all-cause death rate at 6 months. RESULTS: A group of 81 patients was included in the study. The average number of treatments is associated with a significant reduction in the rate of hospitalisations ord deaths at 6 months (p = 0,005); as it concerns the level of titration, the analysing comparing the "therapeutic inertia" group and the "current titration/maximum tolerated dose" group did not reveal any significant difference (p = 0,169). CONCLUSION: Our study highlighted the potential positive impact of the application of the latest ESC recommendations concerning first-line drug treatment on the rate of rehospitalisation or death from all causes, in patients with heart failure reduced LVEF aged over 75.

[IPA exercise at extreme ages of life, differences or similarities?] / Exercice IPA aux âges extrêmes de la vie, différences ou similitudes ?

Advanced practice nursing is intended for children, adolescents, adults and the elderly. In the field of mental health, this population-based approach allows advanced practice nurses to apply all of their skills for individualized and adapted care. Whether these professionals work in child and adolescent psychiatry or in psychiatry for the elderly, their practices have many similarities.

Esboços para uma teoria do sujeito: com Badiou e a psicanálise / Outlines for a theory of the subject: with Badiou and psychoanalysis / Essais pour une théorie du sujet: avec Badiou et la psychanalyse

Partindo-se do pressuposto de que, com Descartes, a questão que subjaz na constituição da modernidade é o que seria o sujeito, este texto se propõe a explorar desdobramentos sobre essa questão tendo como referência teorizações de Alain Badiou e algumas concepções básicas que aprendemos a ler na psicanálise. Ele procura demonstrar os impasses que encontramos ao tentarmos estabelecer formalizações sobre o sujeito, impasses esses que estariam na constituição do homem moderno. Trabalha também interseções e implicações dessas formalizações paradoxais com conceitos igualmente caros à psicanálise, como os de sintoma, corpo e verdade, assim como ressonâncias que poderíamos desdobrar entre a tipologia formal do sujeito proposta por Badiou e formalizações sobre esse tema que poderíamos depreender da leitura das obras de Freud e Lacan.

Based on the assumption that with Descartes the question that underlies the constitution of modernity is what the subject would be, this text proposes to explore developments on this issue with Alain Badiou's theorizations as a reference and some basic concepts that we learn to read in psychoanalysis. He tries to demonstrate the impasses that we find when we try to establish formalizations about the subject, impasses that would be in the constitution of modern humans. It also works on the intersections and implications of these paradoxical formalizations with concepts equally dear to psychoanalysis such as symptom, body, and truth, as well as resonances that we could unfold between the formal typology of the subject proposed by Badiou and formalizations on this theme that we could infer from reading the works by Freud and Lacan.

Sur la base de l'hypothèse que, avec Descartes, la question qui sous-tend la constitution de la modernité est ce qui serait le sujet, ce texte propose d'explorer les développements sur cette question ayant pour référence des théorisations d'Alain Badiou et quelques concepts de base que nous apprenons à lire en psychanalyse. Il essaie de démontrer les impasses que nous trouvons lorsque nous essayons d'établir des formalisations sur le sujet, des impasses qui seraient dans la constitution de l'homme moderne. Il travaille également sur les intersections et implications de ces formalisations paradoxales avec des concepts tout aussi chers à la psychanalyse, tels que les symptômes, le corps et la vérité, ainsi que les résonances que nous pourrions déployer entre la typologie formelle du sujet proposée par Badiou et les formalisations sur ce thème que nous pourrions déduire de la lecture des travaux de Freud et de Lacan.

"Lá onde Isso era, [eu] devo devir": comentário sobre a Lição 21 do Seminário 6, de Lacan / Là où C'était, [je] dois devenir": commentaire de la leçon 21 du Séminaire 6 de Lacan / "Where Id was, [I] must become": commentary on Lesson 21 of Lacan's Seminar 6

O presente trabalho é um comentário da Lição 21 do Seminário sobre O desejo e sua Interpretação de Jacques Lacan. Nessa lição, intitulada. A forma do corte, Lacan percorre a ideia de que a psicanálise se interessa pelo efeito-sujeito, indicando-a a partir da expressão freudiana " Wo Es war, soll Ich werden" e de seus desenvolvimentos a propósito da noção de fantasia, o que inclui o objeto a. O texto percorre essas noções para pensar o trabalho que se realiza numa análise

Cet article est un commentaire de la leçon 21 du séminaire de Jacques Lacan sur Le désir et son interprétation. Dans cette leçon, intitulée La forme de la coupure, Lacan développe l'idée que la psychanalyse s'intéresse à l'effet-sujet, en l'indiquant à partir de l'expression freudienne " Wo Es war, soll Ich werden" et de ses développements sur la notion de fantasme, qui inclut l'objet a. Le texte passe en revue ces notions afin de réfléchir au travail qui s'opère dans une analyse

This paper is a commentary on Lesson 21 of Jacques Lacan's Seminar on "Desire and its Interpretation". In this lesson, entitled "The form of the cut", Lacan goes through the idea that psychoanalysis is interested in the subject-effect, indicating this from the Freudian expression "Wo Es war, soll Ich werden" and its developments with regard to the notion of fantasy, which includes the object a. The text goes through these notions in order to think about the work that takes place in an analysis

[Presbyphagia and swallowing disorders]. / Presbyphagie et troubles de la déglutition.

Swallowing disorders, which are frequent in geriatrics, are linked to multiple pathologies: cancer, stroke, neurocognitive disorders, acute confusion, vigilance disorders, etc. They can have serious consequences and therefore require special care. From the identification of the disorders by the doctor, the nurse, the caregiver, to the speech therapy assessment, through the adaptation of the diet by the dietician, the management of swallowing disorders concerns all the medical and paramedical staff. The aim of this article is to present the main existing recommendations to promote the patient's feeding despite the presence of these disorders.

[Hypertension: Who to treat, to what extent and how?] / Hypertension artérielle : qui traiter, jusqu'où et comment ?

Hypertension is the modifiable risk factor causing the largest loss in healthy life-years. The risk of cardiovascular events increases exponentially with the level of blood pressure (BP), starting from 115mmHg for systolic BP. Out-of-office BP measurements (self-measurements or ambulatory BP measurements) are now preferred for the diagnosis and follow up. In the absence of a preferred indication, antihypertensive treatment is based on thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. These treatments are associated with a significant reduction in morbidity and mortality in people with office BP ≥ 140/90mmHg (self-measurements ≥ 135/85mmHg). For people at high cardiovascular risk, especially those with a history of cardiovascular disease, starting the treatment for an office BP ≥ 130/80mmHg is also beneficial (self-measurements ≥ 130/80mmHg as well). It is now common to start treatment with half-dose dual therapy, which is more effective and better tolerated than full-dose monotherapy. The clinical effect is assessed at 4 weeks and intensification, if required, is then usually done by switching to the same dual therapy at full-dose for both components.

[Study of the impact of a post-acute coronary syndrome pharmaceutical interview in hospital]. / Étude de l'impact d'un entretien pharmaceutique post-syndrome coronarien aigu à l'hôpital.

OBJECTIVES: Post-acute coronary syndrome pharmaceutical interviews were set up in our establishment. The objective of this study was to assess their impact on patient knowledge and their benefit at one year on medication compliance, cardiovascular risk factors (smoking, overweight, dyslipidemia) and the recurrence rate. METHODS: Two groups were formed, an experimental group of patients who had benefited from pharmaceutical interviews and a control group of patients who had not benefited from them. The knowledge of the patients was measured using a quizz carried out before the interview and one month after for the experimental group, then one year after hospitalization for the two groups. A one-year follow-up of medication compliance assessed, control of cardiovascular risk factors and the rate of recurrence of acute coronary syndrome was carried out in both groups. RESULTS: A significant increase in knowledge (P<0.001) after the pharmaceutical interview and its maintenance over time were observed in the experimental group. One year after hospitalization, in the experimental group, the average score on the knowledge quizz (9.2/10) was significantly higher (P<0.005) than that of the control group (6.6/10); medication compliance was significantly better (P<0.05) and greater smoking cessation was observed. CONCLUSIONS: These encouraging results should be highlighted in order to perpetuate and develop such approaches around patient care.

La experiencia de la autonomia humana: salud y subjetividad.Canguilhem y Freud frente a la objetivación del sufrimiento / A experiência da autonomia humana: a saúde e a subjetividade. Canguilhem e Freud sobre a objetificação do sofrimento / The experience of human autonomy: health and subjectivity. Canguilhem and Freud facing the objectification of suffering / L'expérience et l'autonomie humaine: santé et subjectivité. Canguilhem et Freud sur l'objectivation de la souffrance

El artículo examina las nociones de salud y enfermedad elaboradas por los planteamientos de G. Canguilhem. Estas son analizadas tomando en cuenta las hipótesis freudianas relativas a la neurosis, la normalidad y la enfermedad mental. En particular, se aborda el concepto de normatividad en la filosofía de G. Canguilhem, estableciendo un diálogo con las nociones de síntoma y enfermedad en los textos freudianos. En este marco, se da relevancia a la relación entre el síntoma y la fantasía como fenómenos que resaltan la creatividad del ser viviente. Se precisa que esta última se expresa de modo diferenciado en la organización de los cuadros neuróticos y psicóticos. Para finalizar, a través de las ideas expuestas por A. Badiou, se analiza la tensión entre la dimensión objetiva y subjetiva del sujeto, como sustrato lógico de la crítica que puede ser establecida de los procedimientos científico-naturales de la medicina y su afán de objetivación de la experiencia clínica.

O artigo examina as noções de saúde e doença elaboradas pelas abordagens de G. Canguilhem. Elas são analisadas levando-se em conta as hipóteses freudianas sobre neurose, normalidade e doença mental. Em particular, o conceito de normatividade na filosofia de G. Canguilhem é abordado, estabelecendo um diálogo com as noções de sintoma e doença nos textos freudianos. Nessa estrutura, é dada relevância à relação entre sintoma e fantasia como fenômenos que destacam a criatividade do ser vivo. Especifica-se que esta última se expressa de forma diferenciada na organização de quadros neuróticos e psicóticos. Finalmente, por meio das ideias apresentadas por A. Badiou, a tensão entre a dimensão objetiva e subjetiva do sujeito é analisada como um substrato lógico da crítica que pode ser estabelecida aos procedimentos científico-naturais da medicina e sua ânsia de objetivar a experiência clínica.

The article examines the notions of health and illness elaborated by the approaches of G. Canguilhem. These are analyzed addressing Freudian hypotheses concerning neurosis, normality and mental illness. In particular, the concept of normativity in G. Canguilhem's philosophy is approached, establishing a dialogue with the notions of symptom and illness in Freudian texts. In this framework, relevance is given to the relationship between symptom and fantasy as phenomena that highlight the creativity of the living being. It is specified that this creativity is expressed in a differentiated way in the organization of neurotic and psychotic pictures. Finally, through the ideas exposed by A. Badiou, the tension between the objective and subjective dimension of the subject is analyzed as a logical substratum of the critique that can be established of the natural-scientific procedures of medicine and its eagerness to objectify the clinical experience.

L'article examine les notions de santé et de maladie élaborées par les approches de G. Canguilhem. Celles-ci sont analysées en tenant compte des hypothèses freudiennes concernant la névrose, la normalité et la maladie mentale. En particulier, le concept de normativité dans la phi,1tôme et de maladie dans les textes freudiens. Dans ce cadre, l'accent est mis sur la relation entre le symptôme et le fantasme en tant que phénomènes qui mettent en évidence la créativité de l'être vivant. Il est précisé que celle-ci s'exprime de manière différenciée dans l'organisation des tableaux névrotiques et psychotiques. Enfin, à travers les idées avancées par A. Badiou, la tension entre la dimension objective et subjective du sujet est analysée comme un substrat logique de la critique que l'on peut établir des procédures naturelles-scientifiques de la médecine et de son empressement à objectiver l'expérience clinique.

El lugar vacante del concepto de sujeto en la clínica psicoanalítica del autismo / O lugar vago do conceito de sujeito na clínica psicanalítica do autismo / The vacant place of the concept of subject in the psychoanalytic clinic of Autism / La place vacante du concept de sujet dans la clinique psychanalytique de l'autisme

Frente a la hegemonía de abordajes behavioristas y cognitivistas en el acompañamiento precoz del autismo, muchos psicoanalistas tomaron la palabra para criticar dicha universalización, y defender el lugar que el psicoanálisis ocupa. Para ello, se utiliza a menudo el término "sujeto": estas prácticas, dicen los psicoanalistas, excluyen al sujeto, mientras que el psicoanálisis apuesta por su emergencia. Ahora bien, ¿Cuál es el estatuto del sujeto en la clínica psicoanalítica del autismo? A través de una revisión de textos, se puso de manifiesto que para muchos psicoanalistas el sujeto dividido, definido por Lacan, no operaría en el autismo. Al mismo tiempo, no contamos con muchas elaboraciones que propongan un estatuto especifico de sujeto para el autismo. Por consiguiente, se llegó a la conclusión que existe un lugar vacante de dicho concepto en la clínica psicoanalítica del autismo en la orientación lacaniana. En este artículo se proponen tres caminos para reducir la distancia entre una promoción del psicoanálisis como clínica del sujeto y nuestras elaboraciones teóricas sobre el sujeto en el autismo.

Resumos Diante da hegemonia das abordagens behavioristas e cognitivistas no acompanhamento precoce do autismo, muitos psicanalistas têm se manifestado para criticar essa universalização e defender o lugar ocupado pela psicanálise. Para isto, utiliza-se frequentemente o termo "sujeito": essas práticas, dizem os psicanalistas, excluem o sujeito, enquanto a psicanálise aposta em sua emergência. No entanto, qual é o estatuto do sujeito autista na clínica psicanalítica? Através de uma revisão da literatura, verificou-se que para muitos psicanalistas o sujeito dividido, definido por Lacan, não operaria no autismo. Ao mesmo tempo, não temos muitas elaborações que proponham um estatuto de sujeito específico para o autismo. Portanto, concluiu-se que há um lugar vago do conceito de sujeito na clínica psicanalítica do autismo de orientação lacaniana. Neste artigo, três caminhos são propostos para diminuir a distância entre a promoção da psicanálise como clínica do sujeito e nossas elaborações teóricas sobre o sujeito no autismo.

Given the hegemony of behavioral and cognitive approaches in the early accompaniment of autism, many psychoanalysts criticize this universalization and defend the place occupied by psychoanalysis. To do this, the term "subject" is often used: these practices, say psychoanalysts, exclude the subject, whereas psychoanalysis bets on its emergence. However, what is the autistic subject's status in the psychoanalytic clinic? From a texts' review, it appeared that for many psychoanalysts the divided subject, defined by Lacan, would not operate in autism. At the same time, we do not have many elaborations that propose a specific subject status for autism. Therefore, it was concluded that there is a vacant place of the concept of subject in the psychoanalytic clinic of autism of Lacanian orientation. In this article, three paths are proposed to reduce the distance between a promotion of psychoanalysis as a clinic of the subject and our theoretical elaborations on the subject in autism.

Face à l'hégémonie des approches comportementalistes et cognitivistes dans le suivi précoce de l'autisme, de nombreux psychanalystes se sont manifestés pour critiquer cette universalisation et défendre la place occupée par la psychanalyse. Pour cela, le terme « sujet ¼ est souvent utilisé : ces pratiques, disent les psychanalystes, excluent le sujet, alors que la psychanalyse fait le pari de son émergence. Mais quel est le statut du sujet autiste dans la clinique psychanalytique ? Une revue de la littérature a permis de constater que pour de nombreux psychanalystes, le sujet divisé, défini par Lacan, ne serait pas opérant dans l'autisme. En même temps, nous n'avons pas beaucoup d'élaborations qui proposent un statut de sujet spécifique pour l'autisme. On peut donc conclure que la place du concept de sujet dans la clinique psychanalytique de l'autisme d'orientation lacanienne est vacante. Dans cet article, trois pistes sont proposées pour combler le fossé entre la promotion de la psychanalyse comme clinique du sujet et nos élaborations théoriques sur le sujet dans l'autisme..

[Depression in the elderly and the care pathway]. / Dépression du sujet âgé et parcours de soins.

The French population is aging and forecasts for 2040 indicate that seniors could represent a quarter of the population. Depressive illness affects elderly subjects just as much, if not more. There is a clinical specificity of depression in this age group which explains why it is currently under-diagnosed and therefore under-treated. Taking into consideration the care pathway of the depressed elderly subject is a lever to increase the efficiency of access to care and to professionalize the coordinated approach to treatment.

[The place of radiotherapy]. / La place de la radiothérapie.

Radiation therapy (RT) is a key component of the management of elderly breast cancer patients. However, level I evidence in elderly patients is limited. Patient selection should include comorbidities and geriatric assessment. Advances in radiation planning and delivery are improving target coverage, reducing toxicity, and expanding treatment eligibility. Some alternative techniques, such as treatment in the lateral or prone position, may reduce the risk of toxicity. Shorter cycles of hypofractionated whole breast RT are safe and effective. In some cases, partial breast irradiation may be an option.

[Medical oncology treatment]. / Le traitement oncologique médical.

Although patients over 65 years of age represent the majority of breast cancer patients, we have limited data on the safety and efficacy of medical oncology treatments in this population. Their indications are based primarily on expert agreement. This literature review discusses the known data on the safety and efficacy of the main medical treatments for breast cancer: chemotherapy, cytokine-dependent kinase inhibitors 4/6, agents targeting human epidermal growth factor receptor-2, novel antibody conjugates, and immunotherapy.

Por que precisamos diferenciar a pulsão de apoderamento da pulsão de morte? / Why do we differentiate the instinct to master from the death drive? / Pourquoi différencier la pulsion d'emprise de la pulsion de mort? / ¿Por qué necesitamos diferenciar la pulsión de empoderamiento de la pulsión de muerte?

O artigo consiste em um resgate tradutório-conceitual das diferenças entre a pulsão de apoderamento e os aspectos da pulsão de morte. Para sustentar a proposta, apoiamo-nos em Sigmund Freud e no ensino de Jacques Lacan. Considerando que o termo usado por Freud, Bemächtigungstrieb, foi traduzido nas formas de pulsão de dominação e pulsão de apoderamento, defendemos que a segunda possibilidade de tradução permite conceituá-la originariamente, designando a força para apoderar-se do mundo, operacionalizada pelo aparelho muscular. Assim, localizamos sua ação participativa na organização constitutiva do sujeito, sublinhando sua especificidade no terceiro tempo da pulsão, chamada aqui de apassivada. A retomada expõe a distinção da pulsão de morte da ideia de dominação, explorando a natureza do apoderar-se, reabrindo o campo epistemológico.

This article develops a translation-conceptual resumption of the differences between the instinct to master and aspects of the death drive, based on Sigmund Freud and teachings by Jacques Lacan. Since Bemächtigungstrieb, term used by Freud, was translated both as "pulsão de dominação" and "pulsão de apoderamento" in Portuguese, the texts argues that the latter translation allows us to conceptualize it as originally intended, as a force to master the world, operationalized by the muscular apparatus. Thus, we point out its participatory action in the constitutive organization of the subject, underlining its specificity in the third time of the drive, called here passivation. This resumption reveals the distinction between the death drive and the idea of mastery, exploring the nature of taking possession, reopening the epistemological field.

Cet article développe une reprise conceptuelle des différences entre la pulsion d'emprise et la pulsion de mort, en s'appuyant sur Freud et les enseignements de Lacan. Puisque Bemächtigungstrieb, terme utilisé par Freud, a été traduit à la fois par "pulsão de dominação" et "pulsão de apoderamento" en portugais, nous soutenons que cette dernière traduction nous permet de la conceptualiser tel qu'elle était prévue à l'origine, comme une force de maîtrise du monde, opérationnalisée par l'appareil musculaire. Ainsi, on signale son action participative dans l'organisation constitutive du sujet, en soulignant sa singularité dans le tiers temps de la pulsion, appelé ici passivation. Cette reprise révèle la distinction entre la pulsion de mort et l'idée de domination, explorant la nature du "se saisir", rouvrant le champ épistémologique.

Este artículo realiza un rescate de traducción-concepto de las diferencias entre la pulsión de empoderamiento y los aspectos de la pulsión de muerte. Para sostener la propuesta, utilizamos los aportes de Freud y de Jacques Lacan. Considerando que el término Bemächtigungstrieb utilizado por Freud fue traducido como "pulsión de dominio" y "pulsión de empoderamiento", argumentamos que esta segunda posibilidad de traducción permite conceptualizar el término originalmente como una fuerza para apoderarse del mundo, puesta en práctica por el aparato muscular. Así su acción participativa se sitúa en la organización constitutiva del sujeto, subrayando su especificidad en el tercer tiempo de la pulsión llamado aquí pasivación. La reanudación apunta a la distinción entre la pulsión de muerte y la idea de dominio, y explora la naturaleza de la toma de posesión reabriendo su campo epistemológico.

A carta reavida: o lugar do analista e a prática em cuidados paliativos / The letter recovered : the analyst's place and practice in palliative care / La lettre retrouvée: la place et la pratique de l'analyste dans les soins palliatifs / La carta recuperada: el lugar del analista y la práctica en cuidados paliativos

O artigo tem como objetivo refletir sobre o lugar que o analista pode vir a ocupar nos casos de pacientes em cuidados de fim de vida no hospital. A possibilidade de morte iminente, própria dessa clínica, encarna de forma fatídica o encontro com o real como impossível, mote da psicanálise em qualquer circunstância. A partir do relato de caso de uma paciente, acompanhada apenas durante seu último dia de vida, ressaltamos os efeitos possibilitados por uma escuta analítica, na medida em que se deu lugar para as angústias e desejos dos sujeitos envolvidos, e concluímos sobre a importância dessa escuta Outra, em relação à oferecida pela equipe médica. Ao abordarmos o tema dos cuidados paliativos, sublinhamos, por um lado, as dificuldades dos profissionais em lidar com a morte da paciente, e, por outro, problematizamos os impasses colocados pela falta de integralização dessa prática ainda hoje.

Resumos This paper reflects on the place that the analyst can occupy in cases of end-of-life care patients at the hospital setting. The possibility of imminent death in this type of care fatally embodies the encounter with the real as impossible, the motto of psychoanalysis in any circumstance. Based on the case report of a patient's last day of life, the article emphasizes the effects made possible by a psychoanalytical listening, insofar as it gave room to the anguishes and desires of subjects involved, concluding on the importance of such an listening against that provided by the medical team. In discussing palliative care, it both underlines the professionals' difficulties in dealing with patient death, and problematizes the impasses posed by the lack of integration of this practice.

Cet article propose une réflexion sur la place que l'analyste peut occuper face au cas des patients en soins de fin de vie à l'hôpital. La possibilité d'une mort imminente, propre à cette clinique, incarne fatalement la rencontre avec le réel comme impossible, devise de la phychanalyse en toute circonstance. À partir du rapport de cas du dernier jour de vie d'une patiente, l'article souligne les effets rendus possibles par une écoute analytique, dans la mesure où elle à donner place aux angoisses et aux désirs des sujets impliqués, concluant sur l'importance d'une telle écoute contre celle fournie par l'équipe médicale. En abordant les soins palliatifs, il souligne à la fois les difficultés des professionnels à faire face à la mort du patient, et problématise les impasses posées par le manque d'intégration de cette pratique.

El artículo tiene como objetivo reflexionar sobre el lugar que puede llegar a ocupar el analista en los casos de pacientes sometidos a cuidados al final de la vida en el hospital. La posibilidad de muerte inminente, propia de esta clínica, encarna de manera fatídica el encuentro con lo real como imposible, horizonte del psicoanálisis en cualquier circunstancia. A partir del relato de caso de una paciente, seguido solo durante su último día de vida, destacamos los efectos posibilitados por una escucha analítica, en tanto dio lugar a las angustias y deseos de los sujetos involucrados, y concluimos sobre la importancia de una escucha Otra en relación con la asistencia brindada por el equipo médico. Una escucha que, a cambio, pone al equipo y al paciente en el trabajo, y hace que el último movimiento del sujeto del deseo llegue a su destino. Al abordar el tema de los cuidados paliativos, subrayamos, por un lado, las dificultades de los profesionales en el enfrentamiento de la muerte del paciente, y, por otro lado, problematizamos los impasses que plantea la falta de integración de esta práctica aún hoy.