[Management of psychological disorders in patients with chronic hepatitis C]. / L'hépatologue, le psychiatre et les patients ayant une hépatite C.

BACKGROUND: Chronic hepatitis C remains a public heath problem. In France, 400,000 to 500,000 subjects are chronically infected with HCV. LITERATURE FINDINGS: The purpose of this review was first to summarize the clinical aspects of the disease and the guidelines and results of antiviral treatment. The authors focus on the psychiatric side effects of antiviral treatment, and discuss the importance of good patient-provider interaction in patient's satisfaction, highlighting the mandatory role of the dynamic management of patients by hepatologists and psychiastrists. CONCLUSION: Multidisciplinary approaches have to be set up to better treat these patients.

[Organic illness and depression (author's transl)]. / Pathologie organique et dépression.

Depression constitutes a major health problem. Its prevalence in any one year is about 3 per cent of the general population. Most depressed patients are seen by general practitioners, and represent approximately 10 to 18 per cent of their patients. Depression should be present in about 20 per cent of the inpatients in general medicine departments. Depression and organic pathology are very often associated, thus leading to diagnosis mistakes and delays in medical care. Depressions masked by somatic symptoms frequently provoked such mistakes. Depressions occurring during and after medical illnesses, and more specifically chronic illnesses, are often completely neglected. These depressions hinder the patient's readaptation and impair his recovery although they would, in the majority of cases, be accessible to chemotherapeutic and/or psychotherapeutic treatment.

[An open study of Mianserin (author's transl)]. / Etude ouverte de la mainsérine.

The authors present a synthesis of 277 observations collected in France from open studies of mianserin. The product has shown positive results in 65 per cent of the patients considered, based on the global clinical judgement of the prescriber at the beginning and the end of a 28 days open study. The data from Hamilton's scale for depression and Beck's Inventory, even though concerning a smaller number of patients, seem to provide similar results. The improvement appears from the first week, and seems to concern the overall depressive mood, anxiety, psychomotor inhibition, and sleep. The evaluation of the respective results for each target-symptom is made difficult due to the lack of precise data concerning the associated psychotropic drugs. Tolerance has generally been good; there have only been five drop-outs as a result of unpleasant side effects.

[Role of subjective clinical aspects through the evaluation of patients' satisfaction with total arthroplasty of the hip]. / Rôle des éléments cliniques subjectifs pour l'évaluation de la satisfaction des patients après arthroplastie totale de la hanche.

The purpose of this study was to detect subjective elements that came into play with the satisfaction of patients that had been undergoing total hip replacement surgery. None of the patients had ever had a psychiatric pathology or undergone orthopedic surgery before. We defined specific questionnaires in order to support this study, based upon a clinical experience very representative of daily practice. In this study, we have also included the summary of clinical notes which highlight one of the present roles of a psychiatrist in a field which is no longer strictly psychiatric disease. Working daily with surgeons gave us access to patients who do not belong to traditional psychiatry but who need carefully selected words and not only a surgical operation in order to become really relieved. This work demonstrated that the standard quality-of-life questionnaires did not allow to evaluate patients' subjective assessments. In order to take into account this subjectivity, it was necessary to combine questionnaires and open-ended interviews. The analysis of the data gathered in this study showed that half of the patients underwent, roughly 3 months after surgery, a period of temporary frustration, although the hip was already in very good condition, according to objective measures. Patients could get out of this temporary period of disappointment--which seemed to be a necessary stage of mourning of their complaint--without any specific treatment. But a good relationship between surgeon and patient was necessary; it helped the patient and the surgeon to escape a duel or a confrontation. For some patients it may have taken as long as one year to enjoy all the benefits of the operation.

[Prospective study of favorable factors in follow-up of drug addicted patients--apropos of 257 patients of the Cassini Center in Paris]. / Recherche prospective de facteurs favorisant le suivi des toxicomanes--à propos de 257 patients du centre Cassini de Paris.

UNLABELLED: Assessing the effectiveness of treatment is one of the main concerns of any medical process. The different ways proposed for assuming the responsibility of drug addicts and their efficacy are greatly heterogeneous since drug-abusing takes on diverse forms. Thus, in order to closely target the request of drug addicts and adjust their follow-up, we undertook to study prospectively, for 3 months, a population of drug addicts taking medical advice for the first time at the Cassini center in Paris, with the assumption that some predictors may forecast outcomes. METHOD: Data were obtained at the admission with a structured interview about socio-economic and demographic status, psychiatric disorders (assessed clinically according to DSM III-R and with HAD and MADRS scales), substance use and prior treatment history, environmental data (as well as familial substance use or support lending). Medical and paramedical referents have been interviewed after their first contact with the patient about his expectations and his motivation. Familial attendance at this first contact was noted as well as its implication in the programme. At the end of the study, we noted length of stay, regularity of follow up and clinical changes with a last interview of the staff. RESULTS: Half the time, patients' follow up doesn't last a month, drug abuse doesn't change in 6 out of 10 cases, and we only note 14% of durable abstinence. Polydrug abuse (over 80%) is not linked, here, with pejorative outcomes, in opposition to the usual literature. Heroin is the main substance used by our population (over 80%), other opiates, sedatives and alcohol are associated by more than 30% of these patients; cocaine is associated in a quarter of the cases. More than 10% of the patients are concerned by ecstasy and LSD. Cannabis use is common. Medical complaint (mainly viral diseases) at the beginning of the programme, concerns one of two patients. Only a few are initially known as being HIV positive, suggesting a great lack of information. Over forty percent of the patients are given a DSM III-R diagnosis at the end of the first medical advice, when a doubt subsists for a third of the other patients. Major depressive disorder for the first axis and borderline personality disorder for the second axis are the main disorders we founded. We also noted a large ratio (n = 13.5%) of schizophrenic disorders. Univariate analysis: length and regularity of the programmes are key factors of their efficacy. A long follow-up is also required to improve patients' socio-economical status. Initial psychiatric disorders are linked, in our study as well as in literature, with longer stays in therapeutic programms. By revenge, psychiatric disorders at the third month (over 10%) are linked with poorer outcomes. We noted with interest that, in our sample, neither imprisonment in the past (over 40%, but we noted several imprisonments in a case out of two), or intraveinous route at any moment of the patient's life time (40%), or else a programm caused by a court (a quarter of the patients) are of wrong prognosis. Relatives' implication in the programm is linked with favorable outcomes. Multivariate analysis draws 3 independent clusters about the length of stay. One concerns patient's motivation as assessed by medical staff. An other one concerns patient's relatives' implication in the care. A third one is about the begining of the treatment: an initial medical prescrition and a psychological help are linked with favorable outcomes. About the efficacy, multivariate analysis isolates 4 independant clusters. Prior drug abuse programmes (one out of three patients) are associated with poorer outcomes, when, by revenge, familial relationship initially seen by the patient as (very) satisfying, patient's motivation, and, again, an initial medical prescription are linked with better outcomes. The study of those of the patients whose programme lasted more then 3 months but without any appreciable benefit shows that a long follow-up is successful when it is regular, when it provides a socio-economical status improvement and when the patient is given access to insight. For these patients, the (old) age is associated with better outcomes. By revenge, such a 3 months follow-up is not able to reduce drug abuse when a psychiatric disorder exists at the third month. Patients whose treatment was referred by a court don't differ from the others: their length of stay and outcomes are the same. DISCUSSION: Our study confirms our initial hypothesis according to witch subgroups in our population of drug abusers should be isolated and that some predictors of outcomes should be described. Three points seem important to be discussed. First, a medical prescription appears to be important to initiate the relationship between the patient and his practicioner. We have never see any report about this particular point. (ABSTRACT TRUNCATED)

[Psychopathological factors of surgical biopsy within the scope of bone tumors]. / Incidences psychopathologiques de la biopsie chirurgicale dans le cadre des tumeurs osseuses.

Some particularities of cancerous conditions in bone surgery have profound psychological implications for the patients involved: their angst of death is compounded by the fear of mutilation or physical impairment. All medical treatment is undertaken to save the patient's life, but at what cost? The reactions of some patients at different stages of the process, before the diagnosis is established--during a brief stay at the hospital, when biopsy is performed--, when the diagnosis is disclosed and later, during the period of treatment, affect the medical team and are apt to seriously undermine the relationship between doctors and patients. The emergence of a tumor is a major event in a patient's life, even if this tumor eventually turns out to be of the non-malicious kind. Psychological counseling and even the prescription of psychotropic medication may prove necessary: the patient must be helped to cope with a newly acquired sense of powerlessness and the awareness of his or her own mortality. At every step of this personal experience, whether before, during or after the performance of the biopsy, the patient is likely to need help to cope with a sense of anxiety, uncertainty, loneliness, or the consequences of a brutal disclosure of his or her medical condition. Some psychic reactions may take us by surprise. In the first place, we have been puzzled by the discrepancy between the simplicity of the biopsy in operative, surgical terms and the highly emotional reaction it elicited among some patients. To the surgeon, biopsy often amounts to a quick surgical gesture. During their brief stay at the hospital, patients whose condition commands no particular attention are likely to suffer a sense of loneliness while they expect the verdict of the biopsy, and these emotions may be harder to cope with than the implications of serious surgery, should the preliminary analysis require it. Even if it turns out that surgery is not necessary, the anxiety just won't go away and a reactive depression may settle in, oddly enough, one could think. Occasionally, some patients may become aggressive in their dealings with the surgeon, who must remain calm and amenable to have them accept the terms of the treatment. Once the treatment options are reviewed (most of which are stereotypical and codified, a fact that is barely belied by the detailed explanations patiently provided by the medical staff), the patient is left alone to ponder the course and the meaning of life. At this point, life cannot go on under the best possible terms if patients are not offered the opportunity to discuss their physical and moral suffering and if no one is there to listen to complaints that transcend the scope their physical condition.

[A catamnestic study of 73 patients hospitalized in psychiatric units]. / Etude catamnestique de 73 patients hospitalisés en psychiatrie.

The purpose of this study was to describe, among 73 patients, the evolution of their symptoms and the conditions of their psychiatric follow-up care within two years after their first hospitalization. These patients (who had never been hospitalized before in any type of psychiatric unit) were admitted in the psychiatric emergency unit of a general hospital. Five groups were characterized: affective disorders, adaptative disorders, psychotic disorders, substancious disorders, and anxious disorders. The group of affective disorders showed only few improvements in symptoms, although a longer and more regular follow-up care was sustained. The adaptative disorders group had a good prognosis despite a high frequency of follow-up interruptions. Finally, in spite of very frequent symptom aggravations, the group of delusional disorders presented a bad acceptance of psychiatric treatment.

[Psychiatric aspects of Crohn's disease (author's transl)]. / Aspects psychiatriques de la maladie de Crohn.

We have examined 13 patients suffering from Crohn's disease, almost all of them during an active spell. Three patients had a well-structured personality, four patients an obsessional one, one patient a narcissistic personality, and five patients a passive-dependant personality structure. Four patients seemed depressed and anxious. The texts dealing with the psychological aspects of Crohn's disease acknowledge the influence of a stress as a precipitating factor. Patients' passivity and dependence is an idea emphasized by several authors, and the frequency of obsessive personality traits is pointed out in different studies. In short, no author allows us to conclude formally in favour of a psychosomatic origin of Crohn's disease, which confirms our impression after examination of the patients we have talked with or seen regularly.

Dissociation of reading strategies: letter-by-letter reading in the native language and normal reading in the learned language. A case study.

In letter-by-letter reading, which is typically observed in Dejerine's (1892) "pure alexia," oral reading seems to be mediated by the naming of the constituent letters of the printed sequence: reading time rises abnormally as a function of the number of letters of the target item. We describe a patient with fluent aphasia who showed the unusual pattern of letter-by-letter reading together with surface dyslexia in her native language (French) and apparently normal reading in the second, learned language (English). Thus, letter-by-letter reading should be considered as a description of a symptom rather than the consequence of a unique type of functional impairment.

Dot counting by brain damaged subjects.

In this study, we examine how brain damaged adults (aphasics, right-brain lesioned subjects (RBD), and demented subjects) perform a basic education skill: determining the cardinality of different sets of objects (dots). The RBD subjects encountered more difficulty with the spatial correspondence components of the task (correct pointing to the dots), while the aphasics experienced more difficulty with the verbal components (the production of the correct number-word sequence). The deficit evidenced by the demented patients was less systematic. However, qualitative analyses of patients' behavior suggested an organization that tended to minimize the impact of their cognitive deficits on the object-counting task, and an analysis of their counting indicates that the basic counting principles proposed by Gelman (1982) and Fuson (1988) may be preserved.

Calculation and number processing: assessment battery; role of demographic factors.

This paper describes the structure and contents of EC301, a standardized testing battery for the evaluation of brain-damaged adults in the area of calculation and number processing. The battery was administered to 180 normal subjects stratified by education (3 levels), age (3) and gender. EC301 is composed of a large variety of tasks dealing with basic arithmetic skills, and their linguistic, spatial, and mnesic dimensions. The three main notational systems for numbers--Arabic digits, written verbal, and spoken verbal number forms--are explored. Analysis of error rates indicated the effect of some demographic factors (principally, education; incidentally, gender) on normal performance in some tasks.