[Insomnia: definitions, epidemiology and changes with age]. / Insomnie : définitions, épidémiologie et évolution avec l'âge.

INSOMNIA: DEFINITIONS, EPIDEMIOLOGY AND CHANGES WITH AGE. Chronic insomnia is a disorder defined as a subjective complaint relating to the quality and/or quantity of sleep associated with daytime impact, and which must be present 3 nights per week for a period of at least 3 months. This is a common sleep problem in the general population and represents a significant proportion of reasons for consultation in the general practice. It requires early identification at all ages of life to allow the establishment of adequate care, which will have the benefit of both improving the quality of life of these patients in the short term and preventing the consequences of chronic insomnia.

Melancolia e luto na infância e na adolescência: algumas reflexões sobre o papel do objeto interno / Melancholia and mourning in childhood and adolescence: some reflections on the role of the internal object / Melancolía y luto en la infancia y en la adolescencia: algunas reflexiones sobre el papel del objeto interno / La mélancolie et le deuil pendant l'enfance et l'adolescence: quelques réflexions à propos du rôle de l'objet interne

A autora apresenta duas condições bem diferentes que interferem na capacidade de uma pessoa vivenciar o luto: se lamuriar muito e se lamuriar muito pouco. Desde 1917, cinco estados mentais específicos, presentes na descrição da melancolia feita por Freud, foram aprofundados por teóricos subsequentes. Neste artigo a autora concentra-se no quarto e no quinto estado. Menciona os objetos não valorizados em oposição aos objetos valorizados. Considera que todos os desenvolvimentos mais recentes do pensamento psicanalítico se apoiam na grande atenção à teoria das relações objetais e na crescente compreensão da natureza da diferença entre os processos patológicos e benignos projetivos e os processos patológicos e benignos introjetivos.

The author presents two very different conditions, which interfere with a person's capacity to mourn: whimpering too much and whimpering too little. Since 1917, five particular states of mind, which appear in Freud'd description of melancholia, have been developed further by subsequent theorists. This study focuses on the fourth and fifth states. It mentions the unvalued objects, as opposed to the valued objects. It also states that all the newer developments in psychoanalytic thinking are underpinned by the greater attention to the object-relations theory, and by the growing understanding of the nature of the difference between the pathological and benign projective processes, and pathological and benign introjective ones.

La autora presenta dos condiciones muy distintas que interfieren en la capacidad que una persona tiene de vivir el luto: lloriquear mucho y lloriquear muy poco. Desde 1917, cinco estados mentales específicos, presentes en la descripción de la melancolía hecha por Freud, fueron examinados más a fondo por teóricos posteriores. En este artículo la autora se centra en el cuarto y en el quinto estado. Menciona los objetos no apreciados en oposición a los objetos apreciados. Considera que todos los desarrollos más recientes del pensamiento psicoanalítico se respaldan en la gran atención a la teoría de las relaciones objetales en la creciente comprensión de la naturaleza de la diferencia entre os procesos patológicos y benignos proyectivos y los procesos patológicos y benignos introyectados.

L'autrice présente deux conditions très différentes qui interfèrent avec la capacité d'une personne vivre le deuil : se plaindre trop et se plaindre très peu. Depuis 1917, cinq stages mentaux spécifiques, compris dans la description faite par Freud de la mélancolie ont été approfondis par les théoriques qui viennent après lui. Dans cet article l'autrice se focalise sur le quatrième et cinquième stage. Elle mentionne les objets non valorisés en opposition à ceux valorisés. Elle estime que tous les développements les plus récents de la pensée psychanalytique se fondent sur la grande attention donnée à la théorie des relations objectales et sur la compréhension croissante de la nature de la différence entre les processus pathologiques et les processus pathologiques et bénins projectifs et les processus pathologiques et bénins d'introjection.

["All forms of violence against health professionals are an offence"]. / « Toute forme de violence contre des professionnels de santé est un délit ¼.

The law sanctions all forms of violence when there is an impact on the physical and psychological integrity of the person who is subjected to it. This principle also applies in health care facilities. In the event of violence a legal process is launched in order to both sanction the behaviour and compensate the victim. Interview with Gilles Devers, a lawyer at the Lyon bar.

[Listening to physical suffering]. / Entendre la souffrance corporelle.

The psychologist's perspective on the issue of pain opens the way to new issues. One of the psychologist's roles in chronic pain consultations is to allow a psychological elaboration of the painful complaint. It seems essential for the carers, whatever their specialities, to move away from a dualistic "body-mind" concept, so as not to undermine the reception of this complaint, with its multiple interactions.

[The mental health care of unaccompanied minors in children's homes]. / Penser le soin psychique des mineurs non accompagnés en foyer de l'enfance.

Many unaccompanied minors in the care of children's welfare services are housed in a children's home after their assessment. Adapting to this living environment means going from a high level of autonomy to being subject to certain rules, as well as giving oneself permission to settle and accept the support of the educational setting. Care is an important aspect of a children's home: the body is an indicator of the health of these youngsters.

Le placebo, entre éthique et soins.

THE PLACEBO, BETWEEN ETHICS AND CARE: A placebo is used to fight pain, insomnia or anxiety. The placebo effect is said to be this one produced by this 'fake' medication. However, could it not chiefly be the effect produced by the trust relationship established between a patient and a caregiver at a given moment? This article reflects on the results of a survey carried out in the hospital sector.

Indicação de tratamento em psicoterapia de família: relato de uma experiência clínica / Indication of treatment in family psychotherapy: a report of a clinical experience / Indicación de tratamiento en psicoterapia familiar: informe de una experiencia clínica / Indication de cure en psychothérapie familiale: récit d'une expérience clinique

Neste trabalho, as autoras investigam entrevistas preliminares com famílias, feitas numa clínica-escola, procurando analisar que fatores contribuem para a formulação de indicação de psicoterapia de família. Buscam avaliar os parâmetros para essa indicação e quais indicadores, presentes na queixa inicial, devem ser considerados. Com esse fim, apresentam como ilustração clínica um caso atendido na clínica-escola de uma universidade privada. O tratamento ocorreu durante oito meses, com supervisão semanal. As autoras perceberam que, em famílias cujos membros encontram-se emaranhados, a indicação de psicoterapia de família é fundamental. Em tais situações, os limites psíquicos permanecem mal definidos, produzindo rígidas alianças inconscientes, que impedem o desenvolvimento emocional dos membros. Além disso, a escuta lapidada pela experiência do profissional tem se mostrado um fator diferencial na compreensão de uma demanda intersubjetiva e do tipo de encaminhamento terapêutico.

The purpose of this paper is to investigate the preliminary interviews with families in a clinical school. We attempt to examine which factors may contribute towards the formulation of the indication for family psychotherapy. Our intention is to evaluate the parameters of this indication and which indicators, among those that are present in the patient's initial complaint, should be considered. To this end, we present a clinical vignette from a case treated in the clinical school of a private university, i.e., an eight-month treatment with a weekly supervision. We have noticed that in families whose members are entangled, the indication of family psychotherapy is fundamental. In such situations, the psychic boundaries remain poorly defined, so that they produce rigid unconscious alliances that hinder the family members' emotional development. In addition, refined listening skills of an experienced professional has been shown to be a distinguishing characteristic to achieve a better understanding of an intersubjective demand and the type of therapeutic referral.

El objetivo de este estudio fue investigar las entrevistas preliminares con familias en una clínica escuela, tratando de analizar qué factores contribuyen a la formulación de una indicación para una psicoterapia familiar. Buscamos evaluar los parámetros de esta indicación y qué indicadores, presentes en la queja inicial, deben ser considerados. Para ello, se presenta una ilustración clínica, a partir de un caso atendido en una clínica escuela de una universidad privada. El tratamiento se llevó a cabo durante ocho meses, con supervisión semanal. Nos dimos cuenta de que en las familias cuyos miembros están enredados, la indicación de psicoterapia familiar es fundamental. En tales situaciones, los límites psíquicos permanecen mal definidos, produciendo rígidas alianzas inconscientes que obstaculizan el desarrollo emocional de los miembros. Además, se ha demostrado que la escucha refinada por la experiencia profesional es un factor diferencial en la comprensión de una demanda intersubjetiva y el tipo de orientación terapéutica.

Ce travail a pour but l'investigation des entretiens préliminaires avec des familles, dans une clinique-école, en cherchant à analyser quels facteurs contribuent à la formulation d'une indication de psychothérapie de famille. Nous cherchons à estimer les paramètres dont il faut tenir compte et les indices présentes dans la plainte initiale qui doivent être considérés. Pour cela, nous présentons une illustration clinique issue d'un cas soigné dans une clinique-école d'une université privée. Le traitement a eu lieu pendant huit mois, ayant de la supervision hebdomadaire. Nous nous sommes rendu compte que dans des familles dont les membres se trouvent embrouillés, l'indication de psychothérapie de famille est fondamentale. Dans des tels situations, les limites psychiques restent mal définies, tout en produisant des alliances inconscientes rigides qui empêchent le développement émotionnel des membres. En plus, l'écoute lapidée par l'expérience professionnel se montre un facteur différentiel dans la compréhension d'une demande intersubjective et du type d'acheminement thérapeutique.

Ethics and meningiomas: From prudence to obstinacy? The position of the neurosurgeon (for treatment or insurance purposes) in the case of complaints concerning post-operative clinical deterioration.

To treat or not to treat an asymptomatic or pauci-symptomatic benign meningioma, that is the question. And if treatment is necessary, what is the best technique: radical resection, sub-total resection or radiotherapy? This question is also pertinent for meningiomas of the skull base, posterior part of the sagittal sinus, anterior part of the foramen magnum and cerebellopontine angle. When the results of the treatment are good, the patient and the surgeon are satisfied. But when a new neurological deficit appears after the treatment, the patient is entitled to obtain compensation. What should be the position of the specialist medical assessor in this situation when the prognosis of these benign tumors is unknown? Is the preoperative information that is due to the patient complete, objective and sufficient? Is the therapeutic indication unquestionable? Is the technique irreproachable? For meningiomas, there is no "evidence-based medicine"; the therapeutic option is often based on the personal experience and/or the education of the surgeon and thus is, in fact, highly subjective.

[Inequity of compensation trajectories for victims of medical injuries. A survey in the French out-of-court settlement mechanism]. / Inégalités dans les parcours d'indemnisation des victimes d'accidents médicaux. Une enquête au sein du dispositif français de règlement amiable.

BACKGROUND: In France little is known about either the characteristics of people who take legal action because they believe themselves to be victims of harm caused by medical activity, or about their complaint trajectory. The law of 4th March 2002 created an out-of-court settlement mechanism which aims to reduce inequitable access to compensation experienced by victims faced with legal procedures that are both lengthy and costly. This mechanism now occupies a central position among the avenues of recourse available to patients and their families. METHODS: The study relates to the exhaustive database of 18,258 requests for compensation filed with the out-of-court settlement mechanism between 2003 and 2009. It takes 4 series of variables into account: (1) the characteristics of the people concerned by the request, (2) the recourse practices, (3) the result of the requests, (4) the characteristics of the commissions with whom they dealt. Univariate and multivariate analyses were performed, in particular to find factors relating to the different responses given to the requests. RESULTS: Of the requests filed with the out-of-court settlement mechanism, 34.5% led to compensation being awarded, 30.7% were deemed inadmissible and 34.8% were rejected on the basis of expert opinions. The risk of inadmissibility was greater when the victim was a woman, undeceased, or a minor aged between 1 and 17; it bore no relation to standard of living. Recourse to a lawyer (24%) depended on various characteristics, in particular the age and vital status of the victim. It is associated to the decrease of the risk of inadmissibility and to the increase of the chances of receiving compensation. There were significant differences in the ways requests were processed (depending on where they were filed), in the time it took to examine the case, and in the tendency to reject requests before or after expert medical opinion. CONCLUSION: This study offers the first ever description of the population of patients and families who accessed the out-of-court settlement mechanism for medical claims in France. It looks at how, within the mechanism, the diversity of practices impacts inequity and experiences during the compensation process.

[Assessing user satisfaction, an objective for quality of care]. / L'évaluation de la satisfaction des usagers, un enjeu pour la qualité des soins.

The assessment of user satisfaction constitutes a key indicator of the quality of care. It can be envisaged either as part of an internal strategy which favours the improvement of practices, an external strategy whose focus is more commercial and/or an exploratory strategy to develop care models. User satisfaction is expressed in particular through complaint letters and discharge questionnaires. These regulated schemes enable quality to be approached on an individual and collective level.

Entrevistas preliminares em psicoterapia de família: construção da demanda compartilhada / Entrevistas preliminares en la psicoterapia familiar: construcción de una demanda compartida / Les entretiens préliminaires en psychothérapie familiale: construction de une demande partagée

O presente trabalho é produto de uma pesquisa que teve como objetivo investigar o período de entrevistas preliminares com famílias, focalizando a especificidade da avaliação diagnóstica familiar e as implicações da construção da demanda compartilhada para a adesão da família à psicoterapia. A demanda familiar compartilhada foi uma noção desenvolvida neste estudo, significando a motivação latente que conduz o grupo à psicoterapia. Ou seja, corresponde aos conteúdos interpsíquicos que são ainda incompreensíveis para a família, a qual não concebe o sofrimento como algo compartilhado. Postula-se que, no período de entrevistas, é importante problematizar a queixa inicial, por vezes centrada nos conflitos do sujeito-sintoma. As intervenções iniciais visam à realização da transformação do discurso de vitimização dos familiares, conduzindo a um posicionamento conjunto responsável pelo sofrimento psíquico. Na revisão da literatura, foram privilegiadas contribuições tanto da abordagem psicanalítica quanto algumas noções da abordagem sistêmica. Para atingir os objetivos propostos, a pesquisa adotou uma metodologia de estudo de casos clínicos. Foram analisados três casos de psicoterapia familiar, com diferentes queixas e problemáticas. O estudo dos casos se respaldou na análise clínica de conteúdos das entrevistas preliminares e na análise do material projetivo originado da aplicação do Arte Diagnóstico Familiar (ADF), instrumento de avaliação familiar. A descrição dos três casos clínicos ilustra o período de entrevistas preliminares e o trabalho de construção da demanda compartilhada.(AU)

The present work is product of a research that had as objective to investigate the period of preliminary interviews with families, focusing the familiar diagnosis evaluation specificity and the conjoint demand construction implications for the family adhesion to psychotherapy. The conjoint familiar demand was a notion developed in this study, meaning the latent motivation that led the group to the psychotherapy. That is, it corresponds to the interpsychics contents that are still incomprehensible for the family, that does not conceive the suffering as something shared. One claims that, in the period of interviews, it is important to problematize the initial complaint, for times centered in the subject-symptom conflicts. The initial interventions aim the accomplishment of the relatives victimization speech transformation, leading to one responsible joint positioning for the psychic suffering. In the literature review, the psychoanalytic approach was privileged as well as some systemic approach notions. To reach the considered objectives, the research adopted a clinical cases study methodology. Three cases of familiar psychotherapy had been analyzed, with different problematic complaints. The study of the cases was based in the clinical analysis of preliminary interviews contents and in the analysis of the projective material originated from the Family Art Evaluation application- FAD, instrument of familiar evaluation. The three clinical cases descriptions illustrate the preliminary interviews period and the conjoint demand construction work.(AU)

El presente trabajo es el producto de una investigación que tuvo como objetivo investigar el período de entrevistas preliminares con familias, enfocando la especificidad de la evaluación diagnóstica familiar y las implicaciones de la construcción de la demanda compartida para la adhesión de la familia a la psicoterapia. La demanda familiar compartida fue un concepto desarrollado en este estudio, que significa la motivación latente que llevó el grupo a la psicoterapia. Es decir, corresponde a los contenidos interpsíquicos que todavía son incomprensibles para la familia, que no concibe el sufrimiento como algo compartido. Se postula que, en el período de entrevistas, es importante problematizar la queja inicial a veces centrada en los conflictos del sujeto-síntoma. Las intervenciones iniciales tienen como objetivo la realización de la transformación del discurso de la victimización de los familiares, llevando a un posicionamiento conjunto responsable por el sufrimiento psíquico. En la revisión de la literatura, fueron privilegiadas contribuciones tanto del enfoque psicoanalítico como algunas nociones del enfoque sistémico. Para alcanzar los objetivos propuestos, la investigación adoptó una metodología de estudios de casos clínicos. Se analizaron tres casos de psicoterapia familiar, con diferentes quejas y problemáticas. El estudio de los casos cuenta con el respaldo del análisis clínico de contenidos de las entrevistas preliminares y el análisis del material proyectivo de la aplicación del Arte Diagnóstico Familiar (ADF), instrumento de evaluación familiar. La descripción de los tres casos clínicos ilustra el período de entrevistas preliminares y el trabajo de construcción de la demanda compartida.(AU)

Ce travail est le résultat d'une recherche ayant pour but de faire une investigation sur la période des entretiens préliminaires avec les familles, en mettant en lumière la spécificité de l'évaluation diagnostique familiale et les implications de la construction de la demande partagée pour l'adhésion de la famille à la psychotérapie. La demande familiale partagée c'est une notion développée dans cette étude, qui signifie la motivation latente qui a mené le groupe à la psychothérapie. Soit, elle correspond aux contenus interpsychiques que la famille n'est pas encore en condition de comprendre pour ne pas concevoir la souffrance comme quelque chose de partageable. Ce travail postule que, dans la période des entretiens, il est important de reconsidérer la plainte initiale, parfois centrée sur les conflits du sujet-symptôme. Les interventions initiales ont pour but la transformation du discours qui rend victimes les membres de la famille ce qui conduit à un positionnement conjoint responsable de la souffrance psychique. Lors de la révision de la litterature, on a privilégié non seulement les contributions de l'approche psychanalitique, mais aussi qualques notion de l'approche systémique. Pour atteindre les objectifs proposés, la recherche a adopté une méthodologie d'étude des cas cliniques. On a analysé trois cas de psychoterapie familiale présentant desplaintes et des problematiques différentes. L'étude des cas s'est basé sur l'analyse clinique des contenus des entretiens préliminaires et sur l'analyse du matériel projectif issu de l'application de l'Art Diagnostic Familial - ADF, instrument devaluation familiale. La description des trois cas clinique illustre la période d'entretiens préliminaires et le travail de construction de la demande partagée.(AU)

Entrevistas preliminares em psicoterapia de família: construção da demanda compartilhada / Entrevistas preliminares en la psicoterapia familiar: construcción de una demanda compartida / Les entretiens préliminaires en psychothérapie familiale: construction de une demande partagée / Preliminary interviews in family psychotherapy: construction of shared demand

O presente trabalho é produto de uma pesquisa que teve como objetivo investigar o período de entrevistas preliminares com famílias, focalizando a especificidade da avaliação diagnóstica familiar e as implicações da construção da demanda compartilhada para a adesão da família à psicoterapia. A demanda familiar compartilhada foi uma noção desenvolvida neste estudo, significando a motivação latente que conduz o grupo à psicoterapia. Ou seja, corresponde aos conteúdos interpsíquicos que são ainda incompreensíveis para a família, a qual não concebe o sofrimento como algo compartilhado. Postula-se que, no período de entrevistas, é importante problematizar a queixa inicial, por vezes centrada nos conflitos do sujeito-sintoma. As intervenções iniciais visam à realização da transformação do discurso de vitimização dos familiares, conduzindo a um posicionamento conjunto responsável pelo sofrimento psíquico. Na revisão da literatura, foram privilegiadas contribuições tanto da abordagem psicanalítica quanto algumas noções da abordagem sistêmica. Para atingir os objetivos propostos, a pesquisa adotou uma metodologia de estudo de casos clínicos. Foram analisados três casos de psicoterapia familiar, com diferentes queixas e problemáticas. O estudo dos casos se respaldou na análise clínica de conteúdos das entrevistas preliminares e na análise do material projetivo originado da aplicação do Arte Diagnóstico Familiar...

The present work is product of a research that had as objective to investigate the period of preliminary interviews with families, focusing the familiar diagnosis evaluation specificity and the conjoint demand construction implications for the family adhesion to psychotherapy. The conjoint familiar demand was a notion developed in this study, meaning the latent motivation that led the group to the psychotherapy. That is, it corresponds to the interpsychics contents that are still incomprehensible for the family, that does not conceive the suffering as something shared. One claims that, in the period of interviews, it is important to problematize the initial complaint, for times centered in the subject-symptom conflicts. The initial interventions aim the accomplishment of the relatives victimization speech transformation, leading to one responsible joint positioning for the psychic suffering. In the literature review, the psychoanalytic approach was privileged as well as some systemic approach notions. To reach the considered objectives, the research adopted a clinical cases study methodology. Three cases of familiar psychotherapy had been analyzed, with different problematic complaints. The study of the cases was based in the clinical analysis of preliminary interviews contents and in the analysis of the projective material originated from the Family ...

El presente trabajo es el producto de una investigación que tuvo como objetivo investigar el período de entrevistas preliminares con familias, enfocando la especificidad de la evaluación diagnóstica familiar y las implicaciones de la construcción de la demanda compartida para la adhesión de la familia a la psicoterapia. La demanda familiar compartida fue un concepto desarrollado en este estudio, que significa la motivación latente que llevó el grupo a la psicoterapia. Es decir, corresponde a los contenidos interpsíquicos que todavía son incomprensibles para la familia, que no concibe el sufrimiento como algo compartido. Se postula que, en el período de entrevistas, es importante problematizar la queja inicial a veces centrada en los conflictos del sujeto-síntoma. Las intervenciones iniciales tienen como objetivo la realización de la transformación del discurso de la victimización de los familiares, llevando a un posicionamiento conjunto responsable por el sufrimiento psíquico. En la revisión de la literatura, fueron privilegiadas contribuciones tanto del enfoque psicoanalítico como algunas nociones del enfoque sistémico. Para alcanzar los objetivos propuestos, la investigación adoptó una metodología de estudios de casos clínicos. Se analizaron tres casos de psicoterapia familiar, con diferentes quejas y problemáticas. El estudio de los casos cuenta con el respaldo del análisis clínico de contenidos de las entrevistas preliminares y el análisis del material proyectivo de la aplicación del Arte Diagnóstico Familiar ...

Ce travail est le résultat d'une recherche ayant pour but de faire une investigation sur la période des entretiens préliminaires avec les familles, en mettant en lumière la spécificité de l'évaluation diagnostique familiale et les implications de la construction de la demande partagée pour l'adhésion de la famille à la psychotérapie. La demande familiale partagée c'est une notion développée dans cette étude, qui signifie la motivation latente qui a mené le groupe à la psychothérapie. Soit, elle correspond aux contenus interpsychiques que la famille n'est pas encore en condition de comprendre pour ne pas concevoir la souffrance comme quelque chose de partageable. Ce travail postule que, dans la période des entretiens, il est important de reconsidérer la plainte initiale, parfois centrée sur les conflits du sujet-symptôme. Les interventions initiales ont pour but la transformation du discours qui rend victimes les membres de la famille ce qui conduit à un positionnement conjoint responsable de la souffrance psychique. Lors de la révision de la litterature, on a privilégié non seulement les contributions de l'approche psychanalitique, mais aussi qualques notion de l'approche systémique. Pour atteindre les objectifs proposés, la recherche a adopté une méthodologie d'étude des cas cliniques. On a analysé trois cas de psychoterapie familiale présentant desplaintes et des problematiques différentes. L'étude des cas s'est basé sur l'analyse clinique des contenus des entretiens préliminaires et sur l'analyse du matériel projectif issu de l'application de l'Art Diagnostic Familial...