[The pain experience according to a phenomenological view on palliative care]. / Accompagnement psychologique de l'expérience douloureuse en soins palliatifs.

UNLABELLED: In palliative care, people with advanced or terminal phase cancer represent a significant proportion of patients. Persuaded that the pain and suffering they experience will never disappear from their daily life, patients are exposed to successive fracture triggered by psychosocial/physical factors. Furthermore, the difficulty in palliative care is that the pain is also a subjective phenomenon. However, the only information available to indicate pain remains the quantitative assessment of the patient or the observation of his/her behaviour. Pain caused by cancer optimally exhibits the difficulty of pain assessment, where a patient may properly assess, through their somatic pain, their own experience of pain expressed according to the consequence of illness on their history and personality. OBJECTIVES: This exploratory study aims to show how the development of analogical subjective speech has an effect on the pain experience in patients with cancer. Indeed, the hypothesis is that one can reduce the sensation of pain by transforming the emotional experience via a figurative/discursive activity due to an elaboration work and clarification of the painful experience. Method-Four terminally ill patients passed the "L'Épreuve des Trois Arbres" (three-tree test) (ETA), which consisted in drawing trees and telling their story. The ETA aims to facilitate the expression of the overall experience according to a person's perspective on a specific situation. In this experiment, quantitative and qualitative data were collected. More specifically, the quantitative data was based on the assessment of somatic pain using the visual analog scale (VAS) of 1 to 10 (0 = no pain, 10 = unbearable pain) and a qualitative analysis assessed with the ETA, which focused on the meaning of pain, a subjective component that can increase the expression of somatic pain. The pain experience is assessed before and after the execution of the ETA using the VAS. RESULTS: The results show a reduction of painful sensation and its behavioural expression. This could be due to the refocusing of attention and transformation of emotional experience through a figurative and discursive activity. DISCUSSION: The ETA seems to reduce somatic pain by allowing verbalization. The emotional repression of some patients who inhibited the expression of their pain would explain the increase of painful sensation. The psychological approach associated with the theme of the tree offers an opportunity to expound upon the experience of pain in an analogical mode, situating the current painful personal experience in a specific biography. Furthermore, part of the suffering highlighted in protocols was the break that makes the announcement of illness. It generated a sense of rupture between the time before and after, sometimes until a real crisis of identity, which can take on one of the facets of depression. ETA encourages the rebuilding of a psychic continuity between before and after the disease.

[Self concept in falling and non-falling elderly]. / Représentation de soi chez des sujets âgés chuteurs et non chuteurs.

The fall in elderly is frequent and implies great outcomes. Inhibition and turning on oneself mark the post-fall syndrome which illustrates perturbations from fall. This study compares the self concept of old persons with fall and without fall, self concept definited like the perceptions of a subject about himself. Words production is significatively less important for fall subjects and indicates the preponderance of the structure personal Self (SP). The auto description is negative with auto depreciatory, loss of confidence, decreasing of activities, feeling of helpessness in daily life and in future.

[The aging of Down's Syndrome subjects]. / Avancée en âge du sujet atteint d'une trisomie 21.

The normal ageing of Down's Syndrome subjects is comparable to that observed in individuals who have an equivalent cognitive deficit. However it is earlier and is related to the former intellectual level and life story of the person. Before 50 years, there is no significant reduction of memory. After this age short-term memory, the speed of information processing and selective attention weaken. These changes are similar to those in older non-Down's Syndrome defective adults, giving the impression of early ageing in Down's Syndrome subjects. In terms of autonomy in everyday life, it is possible to establish an average evolutionary profile. From 60 years old, deterioration is estimated at 45% of the score obtained at 40 years, affecting in particular the skills necessary for the carrying out daily tasks (washing, dressing, feeding without assistance.). We have little knowledge of the psychiatric evolution of this people because older handicapped people are a new group in society. In the three fields of cognition, autonomy and mental health, the ageing of Down's Syndrome subjects is very sensitive to their environment. Pathological ageing of the Down's Syndrome subject is associated with the dementia syndrome that, with varying degrees, combines disorders of the cognitive functions and behavior, modifying the personality. The clinical diagnosis of dementia is difficult to establish in the Down's Syndrome subject and opinions diverge, also it is important to comply with three rules: 1) to establish an individual base line and to observe, with the help of regular evaluations, a clear change in performance; this must be confirmed by similar modifications in daily conducts; 2) the decline depends not only on the resources of the subject, but also on the demands made by environment; 3) lasting deterioration of capacities must be clearly greater than that observable in normal ageing to signify dementia. As a function of actual age, the Down's Syndrome shows early signs of ageing compared to the general population. One notes the presence of pathological anatomic lesions from 36 years old, which are similar to those observable among patients suffering Alzheimer Disease. However it seems that about 20% of Down's Syndrome subjects do not show clinical signs of dementia 20 years later. The diagnosis, which is delicate to establish, requires an ecological process consistent over time, underlining the influence of the context and the human environment on the ageing of the Down's Syndrome subject.