[Mentalizing in liaison psychiatry ?] / Mentaliser en psychiatrie de liaison ?

In the past few years, there has been an increased and widespread interest for Mentalization-Based Therapies (MBTs). Although originally developed by Anthony Bateman and Peter Fonagy for the treatment of Borderline Personality Disorder (BPD), the scope of MBTs has now been broadened and is relevant in liaison psychiatry, not only to cope with personality disorders or phenomena such as emotional dysregulation and suicidal behaviours, but also because being ill and expericencieng a dependency-laden relationship with health workers tend to reduce mentalization capacities, thereby increasing the probability of misunderstandings, conflicts, treatment drop-outs or medical errors. We provide clinicians with clues to identify failures and reboot the mentalization process among their patients and colleagues.

Les thérapies basées sur la mentalisation (TBM), développées pour le trouble borderline, ont connu ces dernières années un essor important. Les techniques des TBM pourraient être utiles en psychiatrie de liaison au-delà des troubles de la personnalité et de phénomènes comme la dérégulation émotionnelle ou les conduites suicidaires. En effet, le vécu de la maladie et la relation de soin, qui activent puissamment les représentations d'attachement, affaiblissent les capacités de mentalisation du patient et du soignant et, de ce fait, augmentent le risque de malentendus, de conflits, d'interruptions de traitements ou d'erreurs médicales. Nous proposons aux cliniciens quelques pistes pour déceler les failles et restaurer le processus de mentalisation dans le contexte de la psychiatrie de liaison.

CBT/DBT skills training for adults with attention deficit hyperactivity disorder (ADHD).

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is associated with marked impairments in familial, social, and professional functioning. Although stimulant treatments can be effective in adult ADHD, some patients will respond poorly or not at all to medication. Previous studies demonstrated that cognitive behavioural therapy- (CBT) and dialectical behavior therapy- (DBT) oriented interventions are effective in reducing the burden of the disease, which is mainly marked by depression, interpersonal difficulties, low self-esteem, and low quality of life. In order to determine the effectiveness of this intervention, we assessed the benefits of a CBT/DBT programme to reduce residual symptoms and help patients improve their quality of life. SUBJECTS AND METHODS: 49 ADHD-patients, poor responders to medication, were enrolled in a one-year programme where they received individual therapy, associated with weekly sessions of group therapy with different modules: Mindfulness, Emotion Regulation, Interpersonal Effectiveness and Distress Tolerance, Impulsivity/Hyperactivity and Attention. Each subject was assessed at baseline, at months 3 and 6, and at the end of the treatment for ADHD severity (ASRS v1.1), depression severity (BDI-II), hopelessness (BHS), mindfulness skills (KIMS), anger expression and control (STAXI), impulsivity (BIS-11), quality of life (WHOQOL-BREF), and social functioning (QFS). The 49 ADHD patients were compared with 13 ADHD subjects on a waiting list. Linear mixed models were used to measure response to treatment. RESULTS: Overall, the psychotherapeutic treatment was associated with significant improvements in almost all dimensions. The most significant changes were observed for BDI-II (b=-0.30; p<0.0001), ASRS total score (b=-0.16; p<0.0001), and KIMS AwA (b=0.21; p<0.0001), with moderate to large effect sizes. Compared with the waiting list controls, ADHD patients showed a better, albeit non-significant, pattern of response. CONCLUSIONS: Individual and structured psycho-educational DBT/CBT groups support existing data suggesting that a structured psychotherapeutic approach is useful for patients who respond partially or not at all to drug therapy.

"The case of the Beau-Vallon": mental illnesses of deaf people to the psychiatric hospital.

OBJECTIVE: This article aims to examine data on Psychiatric diagnoses among deaf people in comparison with hearing people in the psychiatric hospital in Beau-Vallon. METHOD: This work proposes to study the diagnostic data from the Summary Psychiatric Minimum (Résumé psychiatrique minimum: RPM) from the years 2000 until 2009 from the psychiatric hospital Beau Vallon and for which a hearing problem has been highlighted on Axis III. The sample data of the deaf population will be compared with the sample of the total population represented by all patients for the year 2008. Both samples were found to be equivalent after a Mann-Whitney test to study the relationship between two independent samples with quantitative data. RESULTS: The results show an overrepresentation of the diagnosis of psychotic disorders (40.7% against 29.3%), an equivalence of depressive disorders (18.5% against 18%) but bipolar disorders were absent in the deaf while they were found in 5.7% of patients with normal hearing, an overrepresentation in the deaf population of anxiety disorders (11.1% against 3.4%), intellectual disabilities (37% against 13.4% in the hearing population) and an under-representation of personality disorders (25.9% against 61.2% in the hearing population) CONCLUSION: In this example, several concepts can be put forward to demonstrate bias and prejudice in the specific diagnostic support for deaf people with psychiatric teams who are not specialized in the treatment of deafness.

Does it exist?: "a psychopathology of deafness".

This work aims to study the relationship between psychopathology and deafness. These results show that the most frequent diagnosis among the deaf are disorders of mood and post-traumatic syndrome. Psychotic disorders and mental retardation, once widely diagnosed among deaf populations, are less frequent. The accuracy of these findings results from studies conducted by a team that is specialized in the care of the deaf and that also masters the socio-linguistic aspects of the deaf culture. The high prevalence of erroneous diagnosis posed by non-specialist teams in support of deaf persons, shows the need for the establishment of a bio-psycho-socio-specific language for the deaf.

Screening for attention-deficit/hyperactivity disorder in borderline personality disorder.

BACKGROUND: A valid screening instrument is needed to detect attention-deficit/hyperactivity disorder (ADHD) in treatment-seeking borderline personality disorder (BPD) patients. We aimed to test the performance of the widely-used Adult ADHD Self-Report Scale v1.1 screener (ASRS-v1.1). METHODS: 317 BPD subjects were systematically assessed for comorbid ADHD and completed the ASRS-v1.1. 79 BPD patients also completed the Wender Utah Rating Scale (WURS-25). RESULTS: The prevalence of adult ADHD was of 32.4%. The overall positive predictive value of the ASRS-v1.1 was of 38.5%, the negative predictive value 77.0%, the sensitivity 72.8%, and the specificity 43.9%. Combining WURS-25 and ASRS-v1.1 improved sensitivity to 81.8% and specificity to 59.6%. LIMITATIONS: Cross-sectional study on treatment-seeking patients. CONCLUSIONS: We found a high prevalence of ADHD using structured interviews. The ASRS-v1.1 was not a sensitive screener for identifying possible ADHD cases in a BPD population, with a high number of false positives. When combined with the WURS-25, it offered improved screening.