[Principles of psychiatric sectorization].
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Biomedical subjects
Publications and source records attributed to A Manus.
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The psychiatrist might be called upon for states of pain on two occasions. The first is when the pain is mainly functioned, with or without a previous history of organic pain. It is most frequently met, with various diagnostic difficulties, in hypochondriac neurosis, complaining delirium, schizophrenia, multiple somatizations, isolated psychogenic pain and masked depression. The second is when the pain is organic, always progressive, with associated psychiatric disturbances which interact with it. We shall consider these various problems from both a clinical and a therapeutic point of view aiming at their practical rather than their theoretical aspects.
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The traditional psychiatric structures, such as large mental hospitals, are not ideally suitable for the care of elderly psychiatric patients. Specialized structures are therefore necessary, including small psychogeriatric hospital units, specialized out-patient units, day-hospitals, accommodation in families, sheltered flats and community workshops. In order to create such structures, not only financial resources are needed but also the will to coordinate medical services with social welfare.
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Ten schizophrenic patients were treated with onager oil. It was hypothesized that E1 prostaglandin deficiency underlies the different biological disorders of schizophrenia. The clinical and biological results were disappointing. However the fact that the patients had been severely ill for a long time might have to be taken into account. Moreover, the blood level of gamma-linolenic acid was normal, at the start, in all the patients.
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In this paper, the authors intended to outline the history of three psychiatric and psycho-analytical concepts (negative hallucination, disavowal and scotomisation) and to analyse the psychic processes that they stand for. Historical study: Bernheim coined the expression negative hallucination in 1884. Freud used it from 1895 until 1917 when he discarded it. Freud put forward the concept of disavowal in 1914. In its wider meaning it is equivalent to negative hallucination. In its more specific meaning it designates the simultaneous acknowledgement and non-acknowledgement of a traumatic perception. Scotomisation, introduced by Pichon and Laforgue, is identical to negative hallucination. Freud and Laforgue had a long and polemical discussion about it. Psychological, metapsychological and psychopathological study: Only the concepts of negative hallucination and disavowal, in their more specific meaning, ought to be considered here. In their first phases, both processes are identical. The first phase is a "preliminary position", a conception of things, related to wishes and the pleasure principle. The second phase is marked by a stimulus which is unconsciously perceived as "unbearable". During the third phase, perception is suspended by various processes. It is with the fourth phase that the mechanisms differ. In the negative hallucination, the ego keeps the perception unconscious whereas in disavowal (in its specific meaning) it is split, one part acknowledges the perception, the other disavows it. The authors stress the importance of the negative hallucination and disavowal for psychopathology and psychoanalysis.
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