COVID-19 Health Crisis and Chronic Illness: Protocol for a Qualitative Study.

BACKGROUND: The acute nature of the COVID-19 pandemic has put a strain on health resources that are usually dedicated to chronic illnesses. Resulting changes in care practices and networks have had major repercussions on the experience of people with chronic disorders. OBJECTIVE: This paper presents the protocol of the Parcours, Associations, Réseau, Chronicité, Organisation, Usagers, Retour d'expérience, Soins (PARCOURS)-COVID study. The aim of this study is to evaluate the effects of reorganization of the health system on the usual care network of patients with chronic illness, which fosters and qualifies the quality and continuum of care provided. The first objective of this study is to document these patients' experiences through transformations and adaptations of their network, both in the practical dimension (ie, daily life and care) and subjective dimension (ie, psychosocial experience of illness and relationship to the health system). The second objective of the study is to understand and acknowledge these reorganizations during the COVID-19 lockdown and postlockdown periods. The third objective is to produce better adapted recommendations for patients with chronic illness and value their experience for the management of future health crisis. METHODS: The PARCOURS-COVID study is a qualitative and participatory research involving patient organizations as research partners and members of these organizations as part of the research team. Three group of chronic diseases have been selected regarding the specificities of the care network they mobilize: (1) cystic fibrosis and kidney disease, (2) hemophilia, and (3) mental health disorders. Four consecutive phases will be conducted, including (1) preparatory interviews with medical or associative actors of each pathology field; (2) in-depth individual interviews with patients of each pathology, analyzed using the qualitative method of thematic analysis; (3) results of both these phases will then be triangulated through interviews with members of each patient's care ecosystem; and finally, (4) focus groups will be organized to discuss the results with research participants (ie, representatives of chronic disease associations; patients; and actors of the medical, psychosocial, and family care network) in a research-action framework. RESULTS: The protocol study has undergone a peer review by the French National Research Agency's scientific committee and has been approved by the research ethical committee of the University of Paris (registration number: IRB 00012020-59, June 28, 2020). The project received funding from August 2020 through April 2021. Expected results will be disseminated in 2021 and 2022. CONCLUSIONS: Our findings will better inform the stakes of the current health crisis on the management of patients with chronic illness and, more broadly, any future crisis for a population deemed to be at risk. They will also improve health democracy by supporting better transferability of knowledge between the scientific and citizen communities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/28728.

Interpersonal Synchronization, Motor Coordination, and Control Are Impaired During a Dynamic Imitation Task in Children With Autism Spectrum Disorder.

Background: Impairments in imitation abilities have been commonly described in children with autism spectrum disorder (ASD). How motricity in interpersonal coordination impacts imitation, during long lasting semi-ecological conditions, has not been carefully investigated. Methods: Eighty-five children and adolescents (39 controls with typical development, TD; 29 patients with ASD; 17 patients with developmental coordination disorder, DCD), aged 6 to 20 years, participated to a behavioral paradigm in which participants, standing and moving, interacted with a virtual tightrope walker standing and moving as well. During the protocol, we measured automatically and continuously bodily postures and movements from RGB sensor recording to assess participants' behavioral imitation. Results: We show that (1) interpersonal synchronization (as evidenced by the synchrony between the participant's and the tightrope walker's bars) and (2) motor coordination (as evidenced by the synchrony between the participant's bar and its own head axis) increased with age and were more impaired in patients with ASD. Also, motor control as evidenced by the movement angle standard deviations of participants' bar and head were significantly impaired in ASD compared to TD or DCD. Conclusion: Interpersonal synchronization and motor coordination during ecological interaction show both subtle impairment in children with ASD as compared to children with TD or DCD. These results questioned how motricity mature in terms of motor control and proprioception in children with ASD.

Behavioral Own-Body-Transformations in Children and Adolescents With Typical Development, Autism Spectrum Disorder, and Developmental Coordination Disorder.

Background: In motor imitation, taking a partner's perspective often involves a mental body transformation from an embodied, ego-centered viewpoint to a disembodied, hetero-centered viewpoint. Impairments of both own-body-transformation (OBT) and abnormalities in visual-spatial processing have been reported in patients with neurodevelopmental disorders including autism spectrum disorder (ASD). In the context of a visual-motor interactive task, studying OBT impairments while disentangling the contribution of visual-spatial impairments associated with motor coordination problems has not been investigated. Methods: 85 children and adolescents (39 controls with typical development, TD; 29 patients with ASD; 17 patients with developmental coordination disorder, DCD), aged 6-19 years, participated in a behavioral paradigm in which participants interacted with a virtual tightrope walker (TW) standing and moving with him. The protocol enables to distinguish ego-centered and hetero-centered perspectives. Results: We show that (1) OBT was possible but difficult for children with neurodevelopmental disorders, as well as for TD children, when the task required the participant to perform a mental rotation in order to adopt a hetero-centered perspective. (2) Using multivariate models, hetero-centered perspective score was significantly associated with age, TW orientation, latency, and diagnosis. ASD and TD groups' performances were close and significantly correlated with age. However, it was not the case for DCD, since this group was specifically handicapped by visual-spatial impairments. (3) ASD and DCD did not perform similarly: motor performance as shown by movement amplitude was better in DCD than ASD. ASD motor response was more ambiguous and hardly readable. Conclusion: Changing perspective in a spatial environment is possible for patients with ASD although delayed compared with TD children. In patients with DCD, their visual-spatial impairments negatively modulated their performances in the experiment.

A qualitative study of life events and psychological needs underlying the decision to have cosmetic surgery.

Objective A thorough psychological assessment of patients requesting cosmetic surgery can help to protect them from the risk of postoperative dissatisfaction and the onset and/or aggravation of psychiatric disorders. This study seeks to shed more light on why people desire cosmetic surgery and thus help surgeons, psychiatrists, and psychologists to conduct assessments before surgery. Methods In-depth interviews were conducted with 35 subjects who requested cosmetic surgery. The interviews were recorded and transcribed and then analyzed qualitatively with Grounded Theory. Themes and categories were identified and compared in logical order, to build a consistent theoretical model. Results In each interview, we identified one or more recent events that the subjects considered to be contributing factors in their decisions to have cosmetic surgery. We observed that 33 of 35 patients said they sought cosmetic surgery at a time when they were experiencing, or had just experienced, one or more major changes in their bodies or their relationships. Recent life events triggered or strengthened specific psychological needs in the subjects: to cope with the past and with change, attain a consistent identity, find or regain a positive self-image, alter others' perceptions, define themselves in relation to others, or please themselves or others. Patients said that they chose plastic surgery to fulfill one or more of these needs. Conclusions This study identifies the role of recent events in inciting individuals to resort to cosmetic surgery. This factor provides new perspectives for surgeons to understand those patients and opens new avenues for research.

Freud with Charcot: Freud's discovery and the question of diagnosis.

Although Charcot's seminal role in influencing Freud is widely stated, although Freud's trip to Paris to study with Charcot is well recognized as pivotal in his shift from neurological to psychopathological work, a key fact of the Freudian heuristic remains largely underestimated: namely, that Freud's psychopathological breakthrough, which gave birth to psychoanalysis, cannot be separated from his 'diagnostic preoccupation', which is a crucial and at times the first organizing principle of his earliest writings. The purpose of this article is therefore to reopen the question of diagnosis by following its development along the path leading from Charcot to Freud. The authors demonstrate that Freud's careful attention to diagnostic distinctions follows strictly in the direction of Charcot's 'nosological method'. More importantly, the article intends to identify the precise way in which his ideas operate in Freud's own work, in order to understand how Freud reinvests them to forge his own nosological system. If the authors trace the destiny of Charcot's lessons as they reach Freud's hands, it is the importance granted to mixed neuroses in Freud's psychopathology that allows them to pinpoint the role played by the diagnostic process in the rationality of psychoanalysis.

Mal-estar na civilização e desastre totalitário

O autor interroga a relação entre o desastre totalitário e a psicanálise. Será que a psicanálise, os psicanalistas, tem algo pertinente a dizer acerca da barbárie? Esta não é uma dimensão que estaria fora do nosso campo? Será que podemos afirmar que o desastre que sobreveio na cultura não teria tido senão pouca ou nenhuma consequência sobre nossa "teoria", nossas "práticas", nossa "arte"? Não é incrível que demos seguimento à tarefa psicanalítica como se a onda da irrupção do terror e da barbárie na cultura não tivesse abalado as quatro paredes de nossos consultórios? Estas são perguntas que este artigo enfrenta e que levam o autor a se voltar sobre a questão dos estados limites a partir de sua reflexão acerca dos efeitos psíquicos duradouros do totalitarismo

Malaise in civilization and totalitarian disaster. The author cross-examines the relationship between psychoanalysis and totalitarian disaster. Does psychoanalysis, psychoanalysts, have something relevant to say about the barbarism? Isn't this a dimension which is beyond our field? Can we say that the disaster that befell the culture would not have had but little or no consequence on our "theory", our "practice" our "art"? Isn't it amazing that we follow the psychoanalytic task as if the wave of eruption of terror and barbarism in culture had not shaken the four walls of our offices? These are questions which this article is facing, and leading the author to get back on the issue of borderline states since his reflection on the lasting psychological effects of totalitarianism

Mal-estar na civilização e desastre totalitário / Malaise in civilization and totalitarian disaster

O autor interroga a relação entre o desastre totalitário e a psicanálise. Será que a psicanálise, os psicanalistas, tem algo pertinente a dizer acerca da barbárie? Esta não é uma dimensão que estaria fora do nosso campo? Será que podemos afirmar que o desastre que sobreveio na cultura não teria tido senão pouca ou nenhuma consequência sobre nossa "teoria", nossas "práticas", nossa "arte"? Não é incrível que demos seguimento à tarefa psicanalítica como se a onda da irrupção do terror e da barbárie na cultura não tivesse abalado as quatro paredes de nossos consultórios? Estas são perguntas que este artigo enfrenta e que levam o autor a se voltar sobre a questão dos estados limites a partir de sua reflexão acerca dos efeitos psíquicos duradouros do totalitarismo.

Malaise in civilization and totalitarian disaster. The author cross-examines the relationship between psychoanalysis and totalitarian disaster. Does psychoanalysis, psychoanalysts, have something relevant to say about the barbarism? Isn't this a dimension which is beyond our field? Can we say that the disaster that befell the culture would not have had but little or no consequence on our "theory", our "practice" our "art"? Isn't it amazing that we follow the psychoanalytic task as if the wave of eruption of terror and barbarism in culture had not shaken the four walls of our offices? These are questions which this article is facing, and leading the author to get back on the issue of borderline states since his reflection on the lasting psychological effects of totalitarianism.

A psicanálise tem meios para refletir sobre o mal? Estudo feito em torno do livro “O espírito do mal”, de Nathalie Zaltzman / Does psychoanalysis have tools to think about the evil? A study about the book “the spirit of the evil” by nathalie zaltzman

O papel desempenhado por Nathalie Zaltzman no pensamento e na clínica psicanalítica contemporânea é apresentado pelo autor, tomando como destaque suas reflexões sobre o mal, suas origens e seus efeitos na cultura. Inevitável é o questionamento sobre a posição da psicanálise diante do que denomina o espírito do mal, sua essência e suas incidências no sujeito e nos grupamentos humanos. Decorre daí uma indagação sobre que meios teria a psicanálise para investigar e tratar esse fenômeno que perpassa ao longo de toda nossa história.(AU)

The role of Nathalie Zaltzman in the psychoanalytic thinking and in its contemporary clinic is presenting by the author in her toughts about the evil, its genesis and its effects in the culture. To questio about psychoanalysis’s position when she describes the spirit of the evil, its nature and its incidence in the subject and the human groups is inescapable. Then, it rises a question if the pshychoanalysis would have tools to investigate and treat this phenomenon that is happinning all way trough our history.(AU)

Primeira transferência: afastar a sugestão do somático / First transference: des-suggesting the somatic

Além da simpatia, da empatia, na origem da neurose de transferência, há um ponto central, ponto de antipatia, em que psicanalista e psicanalisando apreendem o real do corpo. Além do corpo psíquico, se entrevê o fundo das coisas: a carne em sofrimento que nunca é vista. Nesse momento do tratamento ouve-se a força de atração do recalcamento orgânico. O autor volta a um momento princeps da invenção freudiana: o sonho 'da injeção de Irmã', para examinar sua hipótese de que o trabalho do sonho revela uma das funções do psíquico – afastar a sugestão do somático.

First transference: des-suggesting the somatic. In the origin of transference neurosis, beyond sympathy and empathy, we can meet an umbilical point, which is an antipathy point where patient and analyst encounter the real of the body. Beyond the psychic body, we can see 'the bottom of things': the suffering flesh, which is never seen. This moment of cure is the one where can be heard the strength of attraction from the organic repression. In order to explore this hypothesis, the author goes back to a moment of Freudian finding: the dream of Irma. He suggests that the work of the dream shows a function of the psychic, which is the desuggestion of somatic.

L'âge: une contre-indication au traitement psychique? / Age: a counter-indication for psychological treatment?

L’âge est-il une contre-indication au traitement psychique ? L’auteur montre que, derrière la question de l’âge, c’est la dimension économique qu’il faut prendre en considération (AU)

É a idade uma contra-indicação para o tratamento psíquico? O autor mostra que, por trás do problema da idade, o que se deve levar em consideração é a dimensão econômica (AU)

Can age be a counter-indication for psychic treatment? The author shows that the economic dimension behind this question must be considered (AU)

L'âge: une contre-indication au traitement psychique? / Age: a counter-indication for psychological treatment?

L’âge est-il une contre-indication au traitement psychique ? L’auteur montre que, derrière la question de l’âge, c’est la dimension économique qu’il faut prendre en considération.

É a idade uma contra-indicação para o tratamento psíquico? O autor mostra que, por trás do problema da idade, o que se deve levar em consideração é a dimensão econômica.

Can age be a counter-indication for psychic treatment? The author shows that the economic dimension behind this question must be considered.

L'etranger de la théorie chez P. Fédida: la théorie de la supervision et le Centre d'Estudes du Vivant / What comes from outside in the theory of P. Fedida: the theory of supervisions and the Center for Studies of the Living

L’auteur montre qu’il y a, chez P. Fédida, une continuité de démarche entre sa théorie de la psychanalyse de supervision et la théorie sur laquelle repose le projet du Centre d’Etudes du Vivant. Tant dans la supervision que dans la controverse entre la psychanalyse et d’autres disciplines, ce qui est en jeu c’est l’étranger de la théorie. Celui-ci défait l’illusion des supposées bases communes de la psychanalyse. C’est à partir de cet interlocuteur “interne” à chaque discipline que peut s’organiser une controverse sur les objets qui sont à la frontière des diverses sciences du vivant(AU)

O autor demonstra que há em P.Fédida, uma continuidade metodológica entre a sua teoria da psicanálise de supervisão e a teoria que embasa o projeto Centre d’Etudes du Vivant. Tanto na supervisão, quanto na controvérsia entre a psicanálise e outras disciplinas, o que está em jogo é o estranho da teoria. Este desfaz a ilusão das supostas bases comuns da psicanálise. É a partir deste interlocutor “interno” de cada disciplina que se consegue organizar uma controvérsia a respeito dos objetos encontrados nos limites das diversas ciências da vida (AU)

The author of this article shows that p. Fédida’s work indicates continuity of thinking between his theory of the psychoanalysis of supervision and the thoery on wich his project for the Centre d’etudes du Vivant is based. In both supervision and in the controversy between psychoanalysis and other areas of knowledge , what is at stake is what comes from outside (l’etranger de la théorie). This is what dismantles the illusion of common bases in psychoanalysis. Starting from this “internal” interlocutor of each discipline, a controversy can emerge concerning objects that are at the edges of the various life sciences (AU)

L'etranger de la théorie chez P. Fédida: la théorie de la supervision et le Centre d'Estudes du Vivant / What comes from outside in the theory of P. Fedida: the theory of supervisions and the Center for Studies of the Living

L’auteur montre qu’il y a, chez P. Fédida, une continuité de démarche entre sa théorie de la psychanalyse de supervision et la théorie sur laquelle repose le projet du Centre d’Etudes du Vivant. Tant dans la supervision que dans la controverse entre la psychanalyse et d’autres disciplines, ce qui est en jeu c’est l’étranger de la théorie. Celui-ci défait l’illusion des supposées bases communes de la psychanalyse. C’est à partir de cet interlocuteur “interne” à chaque discipline que peut s’organiser une controverse sur les objets qui sont à la frontière des diverses sciences du vivant.

O autor demonstra que há em P.Fédida, uma continuidade metodológica entre a sua teoria da psicanálise de supervisão e a teoria que embasa o projeto Centre d’Etudes du Vivant. Tanto na supervisão, quanto na controvérsia entre a psicanálise e outras disciplinas, o que está em jogo é o estranho da teoria. Este desfaz a ilusão das supostas bases comuns da psicanálise. É a partir deste interlocutor “interno” de cada disciplina que se consegue organizar uma controvérsia a respeito dos objetos encontrados nos limites das diversas ciências da vida.

The author of this article shows that p. Fédida’s work indicates continuity of thinking between his theory of the psychoanalysis of supervision and the thoery on wich his project for the Centre d’etudes du Vivant is based. In both supervision and in the controversy between psychoanalysis and other areas of knowledge , what is at stake is what comes from outside (l’etranger de la théorie). This is what dismantles the illusion of common bases in psychoanalysis. Starting from this “internal” interlocutor of each discipline, a controversy can emerge concerning objects that are at the edges of the various life sciences.