[Perception of training in doctor-patient communication for students at faculty of medicine]. / La perception de l'apprentissage à la communication médecin-patient de l'étudiant en Faculté de Médecine.

Doctor-patient communication is the heart of any medical practice. The technology of medicine today is focused on knowledge, its application and know-how, rather than skills of being, of knowing and of knowing when to do nothing. In 2005, Belgian High Council of Health emphasizes a quantitative and qualitative reduction of communication aspects within the initial medical training. The aim of our study is to investigate Belgian and foreign students perception of how the doctor-patient communication was taught during their studies. A questionnaire was sent by email to 300 Belgian and foreign Universities. We obtained 13.6% of answers of 99 students belonging to 41 Faculties from 22 countries. 55.6% of respondents thought to be well trained in the doctor-patient communication. 85.9% of students received theoretical courses out of which only 64.6% have the opportunity to enhance their apprenticeship by practical work. Majority of respondents required more practical work in learning to communicate. All of them agree on that they would like more applied practical communication incorporated into their curriculum. Like wise the society that calls for doctors with increased communication skills and communication researchers who emphasize the central role of the doctor-patient communication in the clinical and therapeutic approach, students are also seeking longitudinal transdisciplinary learning, including more practical practices.

[The psychiatry department]. / Le Service de Psychiatrie.

The Department of Psychiatry was first opened in April 1978. It is one of the largest sector of the hospital and contains 90 beds including a sleep laboratory and an adolescent unit. The clinical activities are broad and multidisciplinary, including novel psychopharmacological and psychotherapeutic and psychosocial approaches. Educational and research activities have also been developed, in particular in the areas of behavioral genetics, sleep physiology, brain imaging and psychosocial research and training.

Social adjustment and the course of affective illness: a one-year controlled longitudinal study involving bipolar and unipolar outpatients.

The association between social adjustment and recurrent affective episodes was examined in 27 recovered bipolar patients and 24 recovered unipolar patients who had been receiving maintenance treatment for at least 1 year. Social adjustment variables and psychiatric status were assessed by bimonthly interviews over the 1-year period using the Social Adjustment Scale (SAS) and the Research Diagnostic Criteria (RDC). Variations in the social adjustment scores were analyzed in the 2 months preceding the onset of a recurrent affective episode. Furthermore, social adjustment variables at entry into the study were assessed to investigate whether there was any association between these and the potential timing of a recurrent episode. Results revealed no significant deterioration in social adjustment during the 2 months preceding a recurrent affective episode. However, it was demonstrated that there was a relationship between a patient's overall social adjustment score at entry into the study and the onset of recurrent affective episodes, independent of any residual depressive symptomatology. Specifically, impaired work adjustment in bipolar and unipolar patients was associated with recurrent episodes. Impaired social and leisure activities adjustment in bipolar patients was also associated with recurrent episodes, and impaired marital adjustment in unipolar patients was associated with recurrent episodes. These results suggest that social maladjustment could be a risk factor for both unipolar and bipolar recurrent affective episodes and that impairment in specific areas of social functioning could be used to predict outcome.

Clinical and psychosocial predictors of recurrence in recovered bipolar and unipolar depressives: a one-year controlled prospective study.

Unipolar and bipolar patients with a chronic illness pattern were investigated to evaluate the relevance of clinical and psychosocial risk factors to predict subsequent recurrence. Self-esteem, social adjustment, social support and attributional style were assessed in 27 recovered bipolar patients, 24 recovered unipolar patients maintained on lithium or antidepressant prophylaxis and 26 healthy controls. They were further interviewed every 2 months in a 1-year period in order to diagnose affective episodes according to Research Diagnostic Criteria. Survival analyses and Cox's regressions demonstrated that being a unipolar patient and showing poor social adjustment were the strongest predictors of the occurrence of affective episodes. Self-esteem, social support, attributional style and clinical characteristics, such as age at illness onset, number of previous episodes or of previous hospitalizations and presence of affective disorder in first-degree relatives, were not found to be risk factors for further recurrence. This study stresses the importance of social adjustment in evaluating the outcome of affectively ill patients maintained on medication prophylaxis.

Life events and primary affective disorders. A one year prospective study.

BACKGROUND: Unipolar and bipolar patients with a chronic illness pattern were investigated to determine whether they experienced a higher number of life events prior to the onset of recurrent affective episodes. METHOD: The study participants consisted of 27 recovered bipolar patients, 24 recovered unipolar patients and 26 healthy control subjects. Life events and psychiatric status were assessed by bimonthly interviews over the period of one year using the Inventory for Recent Life Events and the Research Diagnostic Criteria. RESULTS: In both unipolar and bipolar patients, analyses revealed no significant differences in the number of life events experienced, irrespective of whether the patients had presented with a depressive episode of at least minor intensity during the study (all P > 0.1). Specifically, an increase in marital problems was observed in bipolar patients prior to the onset of recurrent hypomanic and manic episodes (P = 0.06). CONCLUSION: The causal association between life events and the onset of depression, shown to be relevant in non-chronically depressed subjects, does not apply in chronic affective disorders. In addition, our results suggest that marital events have an impact on the onset of recurrent hypomanic and manic episodes.

Psychosocial predictors of major affective recurrences in bipolar disorder: a 4-year longitudinal study of patients on prophylactic treatment.

A total of 21 recovered bipolar patients on prophylactic treatment were prospectively followed up for a period of 1 year. Data for major recurrences were retrospectively collected for an additional 3-year period. During the entire 4-year period, over half of the patients (52%) had no major affective recurrences. Eight patients experienced a major depressive episode, while only two experienced a manic one. Psychosocial and clinical variables were assessed at entry to the study. The effect of these variables on the subsequent 4-year illness course was analysed using survivorship curves. The results show that the following psychosocial variables significantly predicted the occurrence of a major affective episode: low level of social support, maladjustment in social and leisure activities, and poor quality of relationships with extended family. In contrast, clinical variables which characterize illness history were not significantly associated with major recurrences.

Self-esteem in recovered bipolar and unipolar out-patients.

The hypothesis of a low self-esteem in depressive patients was tested using the Rosenberg Self-Esteem Scale in 24 recovered unipolar and 27 recovered bipolar patients, compared with a normal control group of 26 subjects matched for age and sex. The hypothesis was confirmed only for unipolars; bipolar patients presented a self-esteem score not significantly different from normal scores. Self-esteem was not related to clinical characteristics of the affective disorder, suggesting that low self-esteem may be a basic component of a depression-prone personality. The investigation of the relationship between self-esteem and social adjustment confirmed the presence of social conformism in bipolar patients and rigidly set low self-esteem in unipolar patients. These results should stimulate the evaluation of different psychotherapeutic treatments in the long-term psychosocial management of affectively ill patients.

Attributional style and depression: a controlled comparison of remitted unipolar and bipolar patients.

Attributional style was investigated in remitted affective disorder patients (23 unipolars and 26 bipolars) and 26 non-psychiatric controls. We found a specific cognitive vulnerability in unipolars. Unipolars attributed negative events to causes that were more stable--but not more internal nor more global--than bipolars and controls, and did not attach more importance to these events. Attributional vulnerability seemed more apparent in patients with longer histories of depression.

Social adjustment of remitted bipolar and unipolar out-patients. A comparison with age- and sex-matched controls.

Various areas of social adjustment were compared using the Social Adjustment Scale in 27 remitted bipolars, 24 remitted unipolars and 25 normal controls matched for age and sex. Scores for global adjustment and for social and leisure activities were significantly worse in patients than in controls. The maladjustment in social and leisure activities appeared only in 'contact with friends' for bipolar patients and 'diminished social interactions' for unipolar patients. Unipolar patients differed significantly from controls on the items investigating sexual adjustment. In unipolars, social maladjustment seemed to be independent of the course of the disease; in bipolars, it was partly related to the mean number of lifetime episodes and current residual symptoms.

[New diagnostic and neuroendocrine approaches to the borderline syndrome]. / Nouvelles approches diagnostiques et neuroendocriniennes du syndrome "borderline".

The recent literature reflects a growing interest in Borderline Disorders. This paper summarizes the recent developments on nosological, genetical and biological aspects of the Borderline syndrome. Original neuroendocrine results from our group are presented and discussed. They suggest that an endogenomorphic depressive spectrum may be associated with the Borderline personality disorders.