[The impact of the COVID-19 pandemic on the psychological health of healthcare workers]. / Impact de la pandémie de la COVID-19 sur la santé psychologique du personnel soignant.

The world of medicine is particularly affected by the problem of stress. The stress generated by the COVID-19 pandemic has added to the already high mental suffering. Faced with an unanticipated and little-known threat, the organization of health care found itself in turmoil. It is very difficult to predict how significant the impact of this pandemic will be on a psychological and psychiatric level. But, we must be cautious and, above all, put in place a strategy to prevent psychic decompensations in exposed physicians and nursing staff.

Le monde de la médecine est particulièrement touché par la problématique du stress. Le stress généré par la pandémie de la COVID-19 est venu s'ajouter à une souffrance psychique déjà élevée. Face à une menace non anticipée et très peu connue, l'organisation des soins de santé s'est retrouvée bouleversée. Il est très difficile de prévoir quelle va être l'importance de l'impact de cette pandémie sur le plan psychologique et psychiatrique. Mais, on devra faire preuve de prudence et, surtout, mettre en place une stratégie de prévention des décompensations psychiques chez les médecins et membres du personnel soignant exposés.

[Alcohol dependence in primary care : a clinical approach by the GP]. / Prise en charge du mésusage de l'alcool avec dépendance par le médecin généraliste.

Clinical care to patients with alcohol dependence by GP's is described in this article. First, we have to destigmatize these patients and their illness. Diagnosis approach is specified. Therapeutic approach is first a motivational approach; subsequently it's like pedagogy : it's coping. Care is both physical and psychological. Empathy all along therapeutic relationship is a priority and how establishing a therapeutic alliance is described. A psychiatrist, a psychologist, a care network, self-help associations have also to be called on when needed. Physicians education creates new opportunities since 2016-2017 : in particular SSMG (Scientific Society of Primary Care) and three Belgian universities (UCL, ULB and ULiège) introduced a special study program called «?certificat interuniversitaire d'alcoologie?¼. Let's hope this new clinical rewarding approach for GP's contribute to reduce the treatment gap as far as clinical care of patients with alcohol dependence is concerned.

La prise en charge clinique du mésusage d'alcool avec dépendance par le médecin généraliste est décrite dans cet article. Il s'agit, d'abord, de déstigmatiser ces patients et leur pathologie. La démarche diagnostique est précisée. L'approche thérapeutique est, d'abord, motivationnelle; elle prendra, ensuite, des allures pédagogiques : il s'agit de coping. Les soins sont physiques et psychologiques. L'empathie, tout au long de la relation thérapeutique, est fondamentale et les techniques pour créer l'alliance thérapeutique sont décrites. Savoir référer au psychologue, faire appel au réseau, collaborer avec le psychiatre, conseiller l'entraide sont des initiatives nécessaires. La formation des médecins généralistes connaît de nouvelles opportunités : notamment, grâce à un certificat interuniversitaire d'alcoologie mis sur pied à la rentrée académique 2016-2017 à l'initiative de la Société Scientifique de Médecine Générale (SSMG) et de trois universités francophones (UCL, ULB et ULiège). On peut espérer que ces nouvelles pratiques cliniques, valorisantes pour le médecin généraliste, contribueront à réduire le «?treatment gap?¼ dans la prise en charge du mésusage d'alcool avec dépendance, un véritable défi de santé publique.

[Psychiatric complications associated with alcoholism]. / Complications psychiatriques liées à l'alcoolisme.

Psychiatric complications are commonly associated with alcoholism. Psychological symptoms appear during intoxication or in patients with concomitant psychiatric disorders or substance-induced psychiatric disorders. Moreover, the assessment of the psychiatric symptomatology is particularly challenging in patients who express difficulties to accept that the disorder is due to alcoholism. Psychotic reactions, affective disorders and anxiety disorders are the main psychiatric complications of alcoholism.

L'abus d'alcool peut être à l'origine de complications psychiatriques. Les symptômes psychiques peuvent apparaître lors des phases d'intoxication ou être présents chez des patients souffrant de troubles psychiatriques pré-existants ou induits par l'alcool. En outre, l'évaluation de la symptomatologie psychiatrique induite ou exacerbée par l'alcool est rendue particulièrement difficile par les réti-cences qu'ont les patients à accepter que la décompensation puisse être favorisée par la prise de substance. Les décompensations psychotiques, les troubles de l'humeur et les réactions anxieuses sont les manifestations psychopathologiques les plus fréquentes chez les sujets alcooliques.

[School bullying]. / Le harcèlement scolaire. Problématique fréquente dans les cours de récréation mais encore si complexe à résoudre...

School bullying consists of harassment behaviours in a school setting and is characterized by violence acts, mockery or even humiliations between students. More recently, with the development of new technologies, our society has seen the cyber-bullying born. This new type of harassment "on-line" comes and intersects the harassment at school. After the description of a clinical situation, we describe the impact of this phenomenon on the different actors concerned, the lines for prevention and for appropriate support.

Le harcèlement scolaire regroupe des comportements de harcèlement en milieu scolaire et est caractérisé par des violences, des moqueries ou encore des humiliations entre élèves. Plus récemment, avec le développement des nouvelles technologies, notre société a vu éclore le cyber-harcèlement, qui vient s'entrecroiser avec le harcèlement scolaire. Après la description d'une situation clinique, nous décrivons l'impact de ce phénomène sur les différents acteurs concernés, les pistes de prévention et de prise en charge.

[Update on developemental dyspraxia in children]. / Vignette diagnostique de l'étudiant. Le point sur la dyspraxie développementale chez l'enfant.

After having explained what is dyspraxia, we will briefly talk about narcissistic issues related to school term. Indeed, the defensive tools used by children to deal with learning disabilities are varied and not much specific, which will complicate the medical approach. Then we will describe the symptoms that are specific to search in the history and the first clinic appointment in cases of suspected dyspraxia. Finally, we will give details of how we must consider the exploration and the multidisciplinary taking over of the disorder.

Après avoir réexpliqué ce qu'est la dyspraxie, nous aborderons brièvement les enjeux narcissiques liés à la période scolaire. En effet, les moyens défensifs utilisés par les enfants pour faire face aux difficultés d'apprentissage sont variés et peu spécifiques, ce qui rendra la démarche médicale complexe. Nous décrirons ensuite les symptômes spécifiques à rechercher dans l'anamnèse et le premier entretien clinique en cas de suspicion de dyspraxie. Enfin, nous détaillerons la manière dont il faut envisager le bilan d'exploration et la prise en charge pluridisciplinaire du trouble.

[Professional fatigue syndrome (burnout) : Part 2 : from therapeutic management]. / Syndrome de fatigue professionnelle (burnout) 2ème partie : de la prise en charge thérapeutique.

Burnout or professional fatigue syndrome is the result of exposure to a situation in which the strategies of the subject who are supposed to manage the stresses of the environment become outdated and inoperative. An imbalance is created between the demands and the material, operational and psychological resources to cope with them. Many health professions are confronted with the challenge of managing burnout, but the general practitioner is very often on the front line. After a first article devoted to the epidemiology, diagnosis, causes and consequences of the burnout, this second article is focusing on its therapeutic management, through listening, sick leave, dietary supplements, antidepressants, behavioural and cognitive therapy, professional coaching and multidisciplinary approach.

on disponible Résumé : Le burnout ou syndrome de fatigue professionnelle est le résultat de l'exposition à une situation durant laquelle les stratégies du sujet, qui sont censées gérer les stress de l'environnement, deviennent dépassées et inopérantes. Un déséquilibre se crée entre l'exigence des demandes et les ressources matérielles, opérationnelles et psychologiques pour y faire face. De nombreuses professions de santé se trouvent confrontées au défi de la prise en charge du burnout, dont le médecin généraliste. Après un premier article dédié à l'épidémiologie, au diagnostic, aux causes et aux conséquences du burnout, ce second article est consacré à la prise en charge de ce syndrome. Il se centre sur la prise en charge thérapeutique par l'écoute, l'interruption du temps de travail, les compléments alimentaires, les antidépresseurs, la thérapie comportementale et cognitive, le coaching professionnel et l'approche multidisciplinaire.

[Professional fatigue syndrome (burnout). Part 1 : identification by the general practitioner]. / Syndrome de fatigue professionnelle (burnout) 1ère partie : de l'identification par le médecin généraliste.

Burnout or professional fatigue syndrome has never been more talked about than in recent times. It is the result of exposure to a situation in which the strategies of the subject who are supposed to manage the stresses of the environment become outdated and inoperative. An imbalance is created between the demands and the material, operational and psychological resources to cope with them. Many health professions are confronted with the challenge of managing burnout. Among them, the general practitioner is very often on the front line. This paper is dedicated to him in priority. In its first part, it deals successively with the classification of the pathology (ICD-10 and DSM-5), its prevalence, its socio-economic impacts, its clinical picture (three stages), its diagnosis (by clinic and questionnaires), its causes, its evolution (from denial to acceptance), and its long-term consequences in the absence of treatment.

Le burnout ou syndrome de fatigue professionnelle n'a jamais autant fait parler de lui que ces derniers temps. Il est le résultat de l'exposition à une situation durant laquelle les stratégies du sujet, qui sont censées gérer les stress de l'environnement, deviennent dépassées et inopérantes. Un déséquilibre se crée entre l'exigence des demandes et les ressources matérielles, opérationnelles et psychologiques pour y faire face. De nombreuses professions de santé se trouvent confrontées au défi de la prise en charge du burnout. Parmi celles-ci, le médecin généraliste est très souvent en première ligne. Cet article s'adresse à lui en priorité. Dans ce premier volet, il traite successivement de la classification de la pathologie (ICD-10 et DSM-5), de sa prévalence, de ses impacts socio-économiques, de son tableau clinique (trois stades), de son diagnostic (par la clinique et les questionnaires), de ses causes, de son évolution (du déni à l'acceptation) et de ses conséquences à long terme en l'absence de traitement.

[Controversies around the diagnosis of ADHD]. / CONTROVERSES AUTOUR DU DIAGNOSTIC DU TROUBLE DÉFICITAIRE DE L'ATTENTION AVEC OU SANS HYPERACTIVITÉ (TDAH).

Complaints about restlessness, difficulties to focus and impulsivity are amongst the most frequent reasons for child psychiatric consultations. Those complaints refer to the core symptoms of the ADHD. However, the diagnosis of ADHD is delicate to establish and subject to several controversies regarding its etiopathological origins and, therefore, its treatment. In practice, those situations include very different cases and it seems obvious that this is a polyfactorial disorder, no single factor alone being sufficient to account for all the difficulties experienced by the children. It would therefore be simplistic to consider the ADHD as issued only from a neurobiological disorder and to consider a drug treatment, only. We are rather in favor of an integrative approach and a global treatment on a case by case basis.

[MAJOR DEPRESSION AND PERSONALIZED MEDICINE]. / DÉPRESSION MAJEURE ET PRESCRIPTION PERSONNALISÉE.

Depression is a major public health problem. According to the World Health Organization (OMS), depression is currently the second cause of disability in developing countries. Depression is also one of the most frequent mental illnesses. When treating depression, the main objective is to achieve complete remission and to prevent recurrence. Unfor-tunately, in clinical practice, this aim is particularly difficult to reach. Indeed, in clinical trials and in naturalistic studies, remission levels are rather low. The challenge is to individualize the treatment of depression taking account clinical specificities, but also advances in the field of biological and genetic research. Today, intense psychiatric research tries to discover biomarkers to predict treatment response. Because individuals are highly different from a biological, psychological and sociological point of view, more personalized therapeutic approaches are recommended.

[Suicide in the elderly]. / Le suicide chez la personne âgée.

In developed countries, suicide is a real public health problem. However, in contrast with a classical idea, suicide is not specific to young people. Indeed, late life suicide is a cause for major concern, particularly for those over 75 years. Psychiatric disorders, and more specifically major depression, are clearly the most important risk factors. However, socio-environnemental factors, such as life events and social isolation, should not be overlooked. Physical disorders are also important clinical elements. Unfortunately, all these risk factors are not very specific to suicide and the early detection and treatment of people at high risk remain important challenges.

[Depression and type 2 diabetes: etiopathogenic analysis of a frequent comorbidity]. / Dépression et diabète de type 2. Analyse étiopathogénique d'une comorbidité fréquente.

Recent advances in the neurobiology of depression have underlined the importance of markers of inflammation, neurotrophins, and hypothalamo-pituitary adrenal (HPA) axis dysfunction in the development of this pathology. These disorders could have some impact on other systems such as the glucose metabolism regulation with an increased risk of insulin resistance and type 2 diabetes. Type 2 diabetes is also frequently associated with a pro-inflammatory state that could favour the development of a depressive episode. Inflammatory phenomena and HPA axis dysfunction could be biological links between depression and type 2 diabetes and account not only for the frequent association between those two disorders, but also for the treatment-resistance to classical antidepressants.

[Early detection to prevent mental illness during adolescence: ethical and theoretical considerations]. / Détection prévenante en santé mentale chez l'adolescent: considérations éthiques et théoriques.

In the face of changes that characterise adolescence, a number of youth experience ill-being, as part of a normal developmental process. For some of them, however, this ill-being may represent early signs of a psychopathological process. Regarding depression and psychosis, such early signs are non-specific, which complicates and delays treatment. In addition, issues such as stigmatization and unfamiliarity with these psychopathologies represent major obstacles to treatment access. Attempts to early detection, which involves identifying risk factors in order to provide support and follow-up, making an effort to take these clinical signs seriously, while at the same time avoiding to mistake a normal developmental process for a pathological condition.

[Antipsychotics in depression]. / Des antipsychotiques dans la dépression.

Depression is a major public health problem. In the treatment of depression, the main objectives must be complete remission and prevention of recurrence. However, the objective of remission remains difficult in clinical practice. Several pharmacological strategies exist to handle treatment resistant depression and achieve remission. Among these options, addition of an atypical antipsychotic has become a popular choice. Second generation antipsychotics have been investigated in clinical trials in treatment resistant depression and in bipolar depression. Scientific data are available particularly for aripiprazole and quetiapine XR.

[Psychiatric complications and addictions]. / Complications psychiatriques et addictions.

Psychiatric complications are clearly associated with substance abuse. Psychopathological symptoms appear during intoxication or in patients suffering from substance-induced psychiatric disorders. However, the assessment of the psychiatric symptomatology is particularly challenging in patients who express clear difficulties to accept that the disorder is favoured by substance abuse. Psychotic reactions, major depression and anxiety disorders are the main psychiatric issues observed in addict patients.

[Cocaine addiction]. / Addiction à la cocaïne.

Cocaine is the second most commonly used illicit drug after cannabis in the general population. Cocaine is a powerful stimulating agent of the central nervous system and a highly addictogenic drug. Somatic and psychiatric consequences of cocaine addiction are major and clinically relevant. The increasing consumption of cocaine and the importance of its consequences justify an update of our knowledge about cocaine addiction.

[Affective dependency]. / La dépendance affective.

Affective dependency is characterized by emotional distress (insecure attachment) and dependency to another person with a low self-esteem and reassurance need. The paper proposes a reflection on the definition of emotional dependency and the confusion caused by various denominations. Overprotective and authoritarian parenting, cultural and socio-environmental factors may contribute to the development of dependent personality. Psychological epigenetic factors, such as early socio-emotional trauma could > on neuronal circuits in prefronto-limbic regions that are essential for emotional behaviour.We also focus on the interrelations between dependent personality, domestic violence and addictions. The objective for the clinician is to propose a restoration of self-esteem and therapeutic strategies focused on autonomy.

[Hypersexual disorder will not be included in the DSM V : a contextual analysis]. / Le désordre hypersexuel ne figurera pas dans le DSM V : analyse contextuelle.

Hypersexuality disorder has not been added to the list of psychiatric disorders for the Diagnostic and Statistical Manual of Mental Disorders (DSM) V, to be published in May 2013. The evolution of the concept of hypersexuality disorder and its series of different models call into question the controversial context within which its inclusion is considered for the DSM V. A brief contextual analysis makes clear that the creation of this concept follows moral norms and psychosocial values. The construction of hypersexuality disorder in terms of a diagnostic entity rests on the clash of social forces at play in the development process. This article lays the foundation to contemplate the manner in which entities for psychiatric disorders are constructed.

[Pathological gambling : conceptual evolution, clinical characteristics and psychotherapeutical perspectives]. / Le jeu pathologique: évolutions conceptuelles, caractéristiques cliniques et perspectives psychothérapeutiques.

Gambling is a common activity among almost all societies. Forms of gambling have been present all along history, but new gambling behaviours seem to emerge since the development of internet, in a way that we can consider that society has never offered so many opportunities of developing addictive behaviours. Social representations of sin, deviance and crime associated with gambling in the past have disappeared. Gambling now falls within the scope of widespread amusement and socially acceptable activities, whose benefits are not negligible. However, gambling and its impact on individuals who give themselves over to it can be understood as a psychiatric disorder characterized by a loss of control, whose nature and exact place within psychiatric nosology are constantly questioned. Individual as well as group psychotherapeutic care modalities exist. Cognitive-behavioural therapies and their current developments are presented in this article.

[How to cope with the bad reputation of depression]. / Comment s'adapter à la mauvaise réputation de la dépression?

Today, the term depression has lost its meaning. Recent scientific data suggests a change in our classifications of mental disorders. Depression is frequently used to refer to "normal" sadness, anxiety disorders, personality disorders or adjustment disorders... Moreover, in our society, this diagnosis remains badly accepted. It is really time to be aware of the deterioration of the image of psychiatry, and particularly the bad image of depression and its treatment with antidepressants. This paper is a reflexion inviting general practicioners and psychiatrists to progressively avoid the term depression and rather use the diagnosis of unipolar mood disorder, a broader concept, more adapted to new scientific data, less stigmatizing, and closer to the evolution of our society.