[Hypnosis and anxiety problems]. / L'hypnose et les troubles anxieux.

This article describes how hypnosis can be used as an efficient technique in treating patients with anxious disorders. Hypnosis can be used to achieve a better control of the anxious symptoms through relaxation. It allows the patient to anticipate the anxiety triggering events. This technique also allows the patient to mentalise and integrate traumatic events, therefore helping him to prevent the post-traumatic anxious symptoms.

[Post-traumatic stress syndrome in surgery of the hand]. / Le syndrome de stress post-traumatique en chirurgie de la main.

During our collaboration with the Hand Surgery Unit (HCUG), we have managed trauma patients presenting lesions of the upper limb of varying degrees of severity. We were particularly interested in patients who had undergone amputations. We observed that late psychiatric interventions were generally poorly accepted by the patients and were of no use to these patients. In the light of these findings, we therefore elaborated a new strategy of intervention in collaboration with our surgeon colleagues. Patients with severe upper limb trauma were referred to us immediately after their admission. This approach presents three major advantages. Firstly, patients accept support more easily, knowing that they will be faced with psychologically difficult moments; secondly, we can help them to talk about their fears in relation to the future and thereby verbally express their anxieties and can therefore help them to face the future as effectively as possible; thirdly, we play a role in the communication between the surgical team, nursing team and the patient. We believe that this type of intervention improves the conditions of hospitalization and, in the long-term, should decrease the risks of a negative psychiatric outcome.

[Psychogenic spastic hand]. / La main spastique psychogène.

Twelve patients seen over a 8-year period with psychogenic spasms of the hand are reported. Six elderly patients presented with extrinsic flexion of the two or three medial fingers with sparing of the thumb and index. Six other patients had various hand attitudes following coincidental but not causal trauma to the upper extremity. Because of the differences in clinical presentation, age of patients and coincident trauma in some cases, the former patients were characterized as type I psychogenic spasms and the latter as type II. A major recurrent depression was the commonest psychiatric diagnosis (DSM-III-R, Axis I) with a concurrent dependent or borderline personality (DSM-III-R, Axis II). The diagnosis of psychogenic spasm of the hand is a diagnosis of exclusion, that requires a multidisciplinary approach including surgeon, neurologist, psychiatrist and rehabilitation therapist. Electromyographic studies are used to rule out a neurological or muscular etiology of the condition. Surgical treatment was uniformly unsuccessful and is probably contraindicated. Only one patient had a nearly complete spontaneous recovery.