[Inclusion criteria and rating scales for RCTs in Psychiatry. The future of qualitative studies]. / Quels patients inclure et quelles échelles utiliser dans un essai clinique ? Les études qualitatives en perspective.

An inventory on the two critical dimensions that structure the Randomized Controlled Trial in Psychiatry, namely the definition of inclusion criteria for eligible patients for testing and the choice of psychometric methods of pathology assessment and its evolution during the experiment, considers the importance of increasingly numerous and precise international recommendations. Taking into account the formal constraints of industrial, questioning the cultural differences of the methodological approach of the tests, meeting the requirements of feasibility and ever increasing security, frequent cumbersome procedure often contrasts with the modest nature of the results. A better definition to include patients in randomized trials is desirable and it asks to return to the clinic studying the expectations of patients and their response to the therapeutic situation. Excessive standardization otherwise required for ensuring the objective nature of the assessment hampers the collection of original and varied clinical features of importance in the further definitions of indications. On the way to a resumption of the single case study, we can expect from qualitative methods applied to small groups of subjects, optimization principles of patient selection for the upcoming randomized trial and greater chance to address the relevant details of clinical response to the therapeutic situation. This is what has led to the discovery of psychotropic drugs and which is involved in the various modalities of the qualitative approach. For example, and beyond the exploration of clinical drug effects, the study of the experience of psychiatric inpatient care in the Healing Garden, conducted on a small group and on the basis of the narrative analysis of their experience, notes several operating thematic dimensions: a reduction in the perception of symptoms of the disease, the impression of regaining a foothold into reality, the interest of a differently perceived doctor-patient relationship, the advantage of renewed power to act and the recognition of the importance of support from others, patients recovering somehow « vitality ¼ of touch with reality. This suggests the possibility to establish an appropriate rating scale for such a specific therapeutic situation and to provide a more accurate and efficient recruitment for a comparative objective demonstration. Moreover, this construction of meaning reinforces the therapeutic benefit of treatment in Healing Garden and offers new dimensions for research.

[Healing garden: Primary concept]. / Introduction au concept de jardins de soins en psychiatrie.

Since ancient times the relationship between mankind and plants occupies medicine and philosophy. From the first tablets of herbal medicine to Asclepius gardens, those of cloisters and bimaristans to cosmological gardens in Asia, from the largest public park to asylum institutions of the nineteenth century, the garden is proposed as a place of care, a promoter of restoration of the human being. If the advent of technology and drugs have for a time relegated it to the level of empirical care, results in neuroscience ultimately provide it on a scientific basis. The early evolutionary theories, the Savanah theory from Orians, the biophilia hypothesis from Wilson, are relayed by the famous Ulrich' study showing the positive influence of a view of nature through the window on the recovery of in patients. Mechanisms leading stress regulation, level of attention and organisation, focus and fascination, are recognized at the origin of restoration processes. Human capacities to respond to the recuperating function of a natural environment connect to grounded behaviour for adaptation to natural selection process and survival. The mechanisms of our immune system are essential to maintain our vitality. Phyto-resonance, felt or unconsciously perceived in appearance, according to Shepard is an emotion that structures well beyond the archaic behaviour. Recovery, in terms of phenomenological experience of the presence, is a philosophical demonstration of the environmental i.e. multisensory, spatial and temporal approach. Its emotional and affective experience connects to the vitality and creativity. The phyto-resonance hypothesis according to the Konrad Neuberger's point of view induces strategies catering to all levels of the organisation of the human being. It confirms the multidisciplinary nature of hortitherapy and places the mechanism of relationships between man and plant at the centre of discipline. It is also a source of inspiration and inexhaustible work for caregivers. The phenomenological approach of the therapeutic garden is an art of hospitality, human relationships and care. The garden opens the door to our interiority and prepares the interpersonal meeting. The experience of presence, mobilizing internal resources, is an opening to the possibilities of the living world, allows entry into a slow but promising time. The reintroduction and rehabilitation of the garden setting in residential care is necessary. These benefits are open to all for a better efficacy of care.