European Psychiatry
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Le risque du « nommer » avant le « comprendre » est de méconnaître et de sous-estimer l’expérience de la chair que développe Merleau-Ponty [1]. Une expérience qui n’est pas claire une bonne fois pour toute, qu’il tente de restituer par ses formules allusives, transitives pour mieux la cerner, sans la trahir et décrire ce qui se passe aux abords des choses, dans cet entre-deux qui laisse son empreinte dans toute la psychopathologie qui se désire phénoménologique. « Comprendre » et « Voir » avant d’« Interpréter » comme le proclamait Binswanger, c’est ici avoir renoncé à saisir pour mettre l’accent sur la dépossession qui l’accompagne et qui nous ramène à notre passivité originelle. À savoir que les choses sont à laisser être, qu’il peut y avoir de l’être sans qu’il est à être posé, dans la persuasion silencieuse du sensible quand il est là sous la main. Un sensible qui ne cesse d’être ambiguë et transcendant, en se gardant de toute positivité, de toute opération de l’esprit qui peut rapidement dévier vers une pensée opératoire comme le dit la clinique. Comprendre que l’il y a du monde sensible est un il y a d’inhérence, qui nous rattache au monde et nous rapporte à l’être, qui n’est pas devant nous, mais nous entoure de toutes parts dans un rapport charnel que nous sommes condamnés à rechercher encore et encore dès lors que nous en serions privés. Privation du monde et de la présupposition de l’autre, résultats d’une inter-corporéité toujours fragile devant les menaces et leur dépassement qui en même temps m’aident à affermir mes visées et mon identité.
Résumé non reçu.
The Cultural Competent Assertive Community Treatment Team (ACTT) is a joint venture sponsored by Mount Sinai Hospital in partnership with Hong Fook Mental Health Association established in 1999. This is the first ever cultural diverse mental health program using the cultural competency model. It was developed in response to the cultural diverse needs from the culturally diverse communities and supported with the best evidence-based research.
Since the implementation of the program, we focused on identifying key issues that have facilitated or hindered the therapeutic alliances, patients’ service utilization and treatment compliance because of cultural differences in health concepts and health care systems.
We will present what we have learned in literature review and the best evidence-based practice guidelines. Key cultural issues we have encountered with our clients will be described. Methods and strategies that are effective in overcoming cultural differences will be highlighted. We will use a case illustration to demonstrate our innovations and adaptations and will highlight lessons and challenges we have learned during the process of developing the cultural competency model. Feedbacks from the audience would be also incorporated to formulate the “best practice” guidelines. The guidelines will contribute significantly to the understanding of the complexity of cultural factors in treating mental illness but also ensure the effective service delivery to cultural diverse population.
Cultural Competent Assertive Community Treatment Team has won American Psychiatric Foundation Advancing Minority Mental Health Award as well as the Leading Practice Award from Ontario Hospital Association in 2007.
To identify clusters of patients with post-traumatic stress disorder (PTSD) according to symptom profile and to examine the association of the A1 allele of the D2dopamine receptor (DRD2) gene with these clusters.
Fifty-seven untreated Caucasian Vietnam veterans with PTSD were administered the General Health Questionnaire-28 (GHQ) and the Mississippi Scale for combat-related PTSD. DRD2 allelic status was determined by PCR.
Subjects with the DRD2 Al allele compared to those without this allele had significantly higher scores on GHQ 2 (anxiety/insomnia), GHQ 3 (social dysfunction) and GHQ 4 (depression). Cluster analysis of the GHQ data identified two primary groups. A high psychopathology cluster (cluster 3), featured by high co-morbid levels of somatic concerns, anxiety/insomnia, social dysfunction and depression, and a low psychopathology cluster (cluster 1), manifested by the reverse pattern. Scores in each of the four GHQ groups were significantly higher in cluster 3 than cluster 1, as was Mississippi Scale PTSD score. DRD2 A1 allele veterans compared to those without this allele were significantly more likely to be found in the high than the low psychopathology cluster group.
DRD2 variants are associated with severe co-morbid psychopathology in PTSD subjects.
This study was designed to evaluate the effect of semantic priming with a lexical decision task in 22 depressed patients (DSM-III-R, 1987) and 30 control subjects. These patients were evaluated twice: first when they arrived at the hospital, and secondly, after clinical improvement. Clinical improvement was evaluated using standard depression rating scales. A lexical decision task involving semantic relations (related vs. unrelated, e.g., apple-pear) was used to evaluate the processing of semantic information. The results showed that, for the first evaluation, the depressives presented similar semantic priming to control subjects. When we compared semantic priming in the first and the second passes, we observed that its amplitude was identical. The sole difference between the two passes concerns the global reaction time in the depressive group. This last result suggested that, with clinical improvement, the characteristic psychomotor retardation declines. One of the major results concerns the fact that severe depressive patients (first pass) exhibit normal semantic priming in a lexical decision task. These results indicate, in this clinical population, the preservation of controlled processes implicated in this lexical decision task.
Familial aggregation of major depression might indicate a genetic liability for the disorder. The complete disorder or, alternatively, only some individual symptoms might be inherited. Under the latter condition, an increased frequency of inherited symptoms might consecutively increase the likelihood to reach the threshold for depression in relatives and, thus, might cause the familial aggregation of depression. Up to now, no study investigated the possibility of a relationship between individual depressive symptoms and the familial aggregation of depression.
The familial aggregation of early-onset depression (age-at-onset < 60 years, EOD) but less so of late-onset depression (LOD) has been shown in this sample. To assess the hypothesis of an inheritance of individual depressive symptoms as a possible cause of the familial aggregation of depression, frequencies of symptoms were compared in relatives of depressed patients and of controls using forward logistic regression analyses.
Some individual depressive symptoms showed clustering in relatives of patients with depression, but the pattern of inheritance was inconsistent, i.e. the clustering of symptoms was different between non-depressed and depressed relatives of patients with EOD and LOD, respectively. No intra-familial clustering of specific depressive symptoms within families of depressed subjects could be observed.
Due to the inconsistencies in the clustering of individual symptoms in non-depressed and depressed relatives and the lack of intra-familial clustering, the familial aggregation of depression is unlikely to be caused by the aggregation of individual depressive symptoms. An inheritance of the vulnerability for complete depressive disorders influenced by environmental factors is more likely.
There has been no previous systematic research on the pain-related impairment (PRI) system of the AMA Guides. The objective was to examine the emotional distress (ED) status of COPD patients with chronic pain using responses from the Ratings Determining Impairment Associated With Pain (RDIP), a formal assessment for rating PRI by
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