The objective of the present study was to explore the psychological and social mechanisms leading to loneliness. Based on cognitive and behavioral approaches developed in health psychology, we tested several models that might allow one to predict certain determinants of the feeling of loneliness. Included in the study were 45 individuals suffering from loneliness who had come to one of several Centres Thérapeutiques de Lutte contre l'Isolement "Recherche et Rencontres". The subjects were asked to respond to four scales: the UCLA loneliness scale, Cattell's 16 PF 5 personality scale, Sherbourne and Stewart's social support scale, and Lazarus and Folkman's Ways of Coping Checklist. The present results confirm the previously reported deficit of social support perceived by subjects in this population. Concerning their personality, this population sample falls outside national norms in 7 dimensions: compared to the general population, the socially isolated individual appears essentially to be introverted and anxious, emotionally unstable, avoiding conflicts, timid and ill at ease in the company of -others, imaginative and distracted. To face up to their feeling of loneliness, they have a tendency to use coping styles such as "keep it to yourself" and "wishful thinking". On the other hand, they resort very little to social support. Among the pertinent variables, 5 predictive factors were recognized, and they could explain 51% of the variance in the feeling of loneliness: they include the global score of perceived social support, coping strategies focussed around wishful thinking, coping strategies that avoid resort to social support, personality traits of imaginativeness and absent-mindedness, and an introverted personality. Three predictors contributed independently to the model: absence of resort to social support, the use of wishful thinking, and the imaginative-distracted personality trait. We likewise found evidence for a mediator role of the absence of resort to social support in the relation between the levels of perceived social support and the feeling of loneliness. Thus it is not so much the deficit in the subject's social relations that determines his feeling of loneliness as it is his difficulty of appealing to others when in distress. These results suggest that it would be judicious to develop specific therapeutic interventions for this type of person that would permit them to adjust more actively and to behave more realistically.

Adaptation, Psychological↗

PubMedDate not supplied

[Posttraumatic stress state: a therapeutic lever].

Chronic post-traumatic stress disorder (PTSD) is a very complex syndrome which is hard to detect because of the multiplicity of its expressions. Further more, these clinical expressions are far from the "pure" syndrome described in the DSM IV. So, the clinician faces a dilemma: how can he account for the traumatic clues without using the PTSD as a ragbag of a diagnosis? We found the way to discard this dilemma when we decided to use what M. Struber said about her experience with cancer and PTSD. She suggests not to emphasize psychopathology and to use a post-traumatic stress framework. This way to reframe some psychiatric urgencies is very useful because it gives back ability to the patient. When using a post-traumatic stress framework we tell the patient and his family that we acknowledge he has defensible reasons for not managing with an event which, we acknowledge too, was traumatic for him. In that way we begin to explore what each person is experiencing, because the traumatic experiencing is generally shared by the patient and his family. The members of the family are often angry and fed up of the patient behaviour and think themselves as victims of him. On the other part, the patient feels himself as a misunderstood person, victim of the others. The primary trauma is forgotten for a long time or nobody make any link between it and what is happening in the present. The manifestations of the PTSD initiate subsequent aftermaths and suffering for everybody. When working with psychiatric emergencies, we have to manage with acute situations in which each people is both victim and aggressor and in which clinicians run the risk of being given the role of either victim or aggressor. The trial of strength played between the patient and his family is going to be played with the clinician. These situations are described by S. Lamarre when she speaks of "victimisation" and are overloaded with control stake. Each one tries to make the other guilty and disgraced, and the clinician is at risk to feel and/or make feel in the same way the patient and his family. These situations are blocked and the temptation is to resort to a kind of coup when the clinician decides it's enough! and forces his opinion and decision. What is not a very good way to create the essential therapeutic co-operation! In this article we show how using a post-traumatic stress framework is very useful to reframe the situation of "victimisation", give the opportunity to discard its trap, open a new sight which allows to find new solutions and promote a therapeutic co-operation. It's important to stress the fact that it's not efficient to use a post-traumatic stress framework as a formula. The clinician who uses it has to feel it, otherwise he will be unable to co-create this new reality with the system he entered, when receiving the emergency.

Alcoholism↗

PubMedDate not supplied

[Patient and their relatives' satisfaction regarding a home-based crisis intervention provided by a mobile crisis team].

The goal of this survey was to evaluate the patients and their relatives' satisfaction with a home-based crisis intervention provided by a psychiatric mobile crisis team (Equipe Rapide d'Intervention de Crise, hôpital Charcot, Plaisir). We were particularly interested in measuring satisfaction with telephone response time, team mobility, patient welcome, family consultations, information given to patients and the number of caregivers. We designed a questionnaire that included 24 closed questions and 2 open-ended questions. Replies were collected over the telephone by an outside psychologist with no prior knowledge of the patients. The inclusion criteria were the following: the patient had to have received a home-based crisis intervention from the mobile crisis team and to have received at least two follow-up consultations. The response rate was 95%, from 81 relatives and 73 patients. The results show a high level of overall satisfaction, with satisfaction levels at over 90% for some of the questions. High satisfaction was due to the human and professional approach of staff - their listening skills and competence - the 24-hour availability of the telephone service, the fast intervention of the team, the team mobility, and the systematic involvement of relatives as part of the program. Low satisfaction was due to the high number of caregivers, the short length of programs, the patient referral process to outpatient services, the lack of information on medication and patients' illness and the sad appearance of the building. These results lead us to improve some aspects of our service or at least to explain our services more fully to clients. More generally, these results encourage us to listen more attentively to patients' opinions on how they experience their psychiatric care.

Adult↗

PubMedDate not supplied

[Diagnostic approach in renal tumoral syndromes using modern explorations and especially arteriography following angiotensin].

Explore the source record for details and available documents.

Angiography↗

PubMedDate not supplied

[Study of the HL-A system in Basedow's disease (author's transl)].

HL-A typing has been carried out in 100 caucasians with Graves' disease and compared with 270 healthy controls. 25 HL-A antigens were characterized using a lymphocytotoxicity microtechnique. Analysis of the results reveals an increased incidence of HL-A8 antigen (35% in patients as compared to 16,3% in controls), with a high degree of statistical significance: p=0.0002 and corrected p X 25) = 0.005. We did not observe a clearcut correlation between the presence of HL-A8 and different characteristics of the disease: sex, age of onset, familial history, exophtalmia, goiter, severity. The knowledge of the relationships between the HL-A8 gene and several auto-immune diseases is a strong argument in favor of the auto-immune nature of Graves' disease. The association between HL-A8 and Graves' disease could be explained by a close linkage between the second HL-A locus and one or several Ir-IgG loci occupied in predisposed individuals by predisposing alleles. In these subjects, an antigenic contact with an exogenous etiological agent would induce a pathological immune response, with production of thyroid stimulating IgG.

Graves Disease↗

PubMedDate not supplied

[HLA B8 and Graves' disease (author's transl)].

HLA typing has been carried out in 100 caucasions with Graves' disease and compared with 270 healthy controls. 25 HL-A antigens were characterized using a lymphocytotoxicity micro-technique. Analysis of the results reveals an increased incidence of HLA-B8 antigen (35% in patients as compared to 16.3% in controls) with a high degree of statistical significance: p = 0.0002 and corrected p (X 25) = 0.005. We did not observe a clear-cut correlation between the presence of HLA-B8 and different characteristics of the disease: sex, age of onset, familial history, exophtalmia, goiter, severity. The knowledge of the relationships between the HLA B8 gene and several auto-immune diseases is a strong argument in favor of the auto-immune nature of Graves' disease. The association between HLA B8 and Graves' disease could be explained by a close linkage between the second HLA locus and one or several Ir-IrG loci, occupied in predisposed individuals by "predisposing" alleles. In these subjects, an antigenic contact with an exogenous etiological agent would induce a pathological immune response, with production of thyroid stimulating IgG.

Adult↗

PubMedDate not supplied

[Questionnaire on professional satisfaction with psychiatric emergency services: the professionals' opinion].

Professional's satisfaction concerning medical wards to which they address their patients are scarce, but is part of quality evaluation. The primary care network criticizes often the access to specialized psychiatric cares in emergency. The rapid emergency crisis team (ERIC) is a mobile emergency and post-emergency crisis team depending from public services. It has for purpose to offer early access to specialized care before admission to psychiatric hospital, which general practitioners or other members of social network alert it for a crisis psychiatric situation. The aim of this study was to evaluate the adequacy of ERIC to the needs of professionals, and to improve the collaboration within the network. We performed a mailed study using a questionnaire to 150 general practitioners, 25 private psychiatrists, 7 social circonscriptions, and 5 police departments depending on our intervention's catchment area. Forty-two percent of the professionals answered. Emergency psychiatric crisis situations are scarce, and professional's satisfaction is excellent. ERIC is considered as useful, and the accessibility is underlined. However, information transmitted at the end of the intervention is criticized by the professionals. This study allows to improve some of the procedures and will help to an evolution of our functioning. Moreover, it allows to propose a strategy of prevention oriented to early access to specialized cares.

Catchment Area, Health↗

PubMedDate not supplied

[Suicidal action and sacrificial violence: systemic and anthropological hypothesis].

Studies concerning suicidal behavior show practical limitations of epidemiology and risk factor analysis. Suicidal behaviour is usually considered as a consequence of mental disease, but suicide cannot be studied without addressing the context of the acting-out. Suicide attempt can be interpreted as a thematic relational act, in which the central phenomenon is anger. Using the anthropological hypothesis of scapegoating described by René Girard and a theoretical systemic approach, we propose a vision of suicide attempts in a micro-social context, offering a new interpretation of the acting-out. Application of the hypothesis to the suicidal context shows that suicidal behavior may be considered as a relationship modality. The understanding of rivalry mechanisms and integration of care in a context which takes account of the complexity of suicidal behaviour offers the possibility of developing potentially valuable approaches to prevention.

Acting Out↗

PubMedDate not supplied

[Managing adolescent and adult victims of extra-familial rape soon after aggression].

Rape victims often experience severe and prolonged symptoms in the aftermath of the assault. Psychological assistance offered rapidly after the assault should mitigate the intensity and moderate the duration of rape-related problems. This paper tried to identify the widely-accepted therapeutic approaches from a review of the current literature; it has its roots in the clinical experience acquired by our mobile crisis service in this type of situation, too. The goal of the following practices concerning the victim and the victim's immediate family is to assist the victim to reclaim control as quickly as possible over what has happened and to return to a normal functioning. The therapist should adopt an empathetic attitude, actively and instructively, even more so, and in an even more flexible way than for other patients. Knowledge of one's potential reactions to that kind of situation is useful since the counter-transference is here particularly intense. Doubting the patient's word is part of these negative reactions and must be avoided. It is better to respect the victim's feelings of guilt in the first instance. The relating of the facts, despite its cathartic value, should not be imposed on the patient. It should be noted that these last two points are controversial. It is also important to give information, during interviews, about the symptoms which can occur, the defence mechanisms that the individual sets up for just such occasions and on the most common difficulties encountered in personal relationships. In particular, the therapist must verify that concrete measures are taken to protect the victim against another attack. As far as the immediate family is concerned, it seems particularly important to involve them and, better still, meet them. Their reaction to the rape has a determining influence on the victim's capacity to cope with the trauma and its consequences. On the one hand, the immediate family should be helped in giving support to the victim by telling them all the details of what the patient could suffer, their potential reaction towards the victim and the victim's potential reactions towards them. The question of security must also be brought up with the family, in particular the risk of suicide which can be great. On the other hand, it is important to meet the family to give them support because they too may have difficulty in coming to terms with the violence of the aggression and its consequences. These approaches are up to now the only guidelines available since no psychotherapeutic technique (based on controlled studies) has proved to be more efficient than another and since the clinical experience of the authors are leading them to opposite therapeutic options. Different psychotherapeutic techniques are recommended: short therapies such as cognitive-behavioural therapies or hypnosis, or longer ones such as psychoanalytic psychotherapy. Several of these different options, to which must be added physical techniques like relaxation and medication, are often used simultaneously and/or in succession. As for drug treatments no controlled study conducted with this population has proved their efficiency on post-traumatic stress disorder. According to us they are essentially useful in order to diminish the intensity of the symptoms of anxiety.

Adolescent↗

PubMedDate not supplied

[Proceedings: Kinetics and disposal rate of triiodothyronine in patients with atuonomous hot nodular goiter, with or without thyrotoxicosis (author's transl)].

Eight female patients are studied, four of them without hyperthyroidism. The following were measured before and after surgery = hormonal iodine by column, serum concentrations of T T3, AF T3, TSH, total T3 distribution space, T3 pool size T3 fractional turnover rate. T T3 is measured in the serum of peripheral venous blood, nodular venous blood and of jugular venous blood of the opposite side of the adenoma. Before surgery, the mean of T T3 in patients with hyperthyroidism is increased in serum obtained from brachial and not nodule venous blood. Are also increased AF T3 and T3 production rate. In patients without hyperthyroidism, T T3, AF T3 are increased in two subjects only, but T3 production rate is rised among three of them. After surgery the previous values are not different with normal values. These data are in good agreement with the hypothesis that, in patients without thyrotoxicosis, there is an increase in T3 production from not nodular goiter. There phenomena may explain unresponsiveness to TRH test and inactivity of normal thyroid. Absence of hyperthyroidism may be due to a lack of sensitivity of peripheral tissues to the increase of T3.

Female↗