The objective of this ongoing multicentric study is to evaluate if the INTERMED (IM), a screening... more The objective of this ongoing multicentric study is to evaluate if the INTERMED (IM), a screening instrument to assess case complexity, identifies patients at risk for unfavourable postoperative development. Methods: So far, 217 kidney (KTX) and liver (LTX) transplant patients
ObjectivesTo assess the self-reported prevalence of sexism and sexual harassment at a Swiss medic... more ObjectivesTo assess the self-reported prevalence of sexism and sexual harassment at a Swiss medical school, and to investigate their association with mental health. Research hypotheses were an association between sexism/sexual harassment and poor mental health and a higher prevalence of sexism/sexual harassment in clinical rotations.DesignCross-sectional study as a part of ETMED-L project, an ongoing cohort study of interpersonal competences and mental health of medical students.SettingSingle-centre Swiss study using an online survey submitted to medical students.ParticipantsFrom 2096 registered students, 1059 were respondents (50.52%). We excluded 26 participants (25 due to wrong answers to attention questions, and 1 who did not answer the sexism exposure question). The final sample (N=1033) included 720 women, 300 men and 13 non-binary people.MeasuresPrevalence of self-reported exposure to sexism/sexual harassment. Multivariate regression analyses of association between being targ...
Aim: The objective of this ongoing multicentric study is to evaluate if the INTERMED (IM), a scre... more Aim: The objective of this ongoing multicentric study is to evaluate if the INTERMED (IM), a screening instrument to assess case complexity, identifies patients at risk for unfavourable postoperative development. Methods: So far, 217 kidney (KTX) and liver (LTX) transplant patients were evaluated preoperatively and 70 of them at 12 months post transplant. Biopsychosocial profiles were assessed using the IM. Quality of life [Short Form 36 (SF-36)] and depressive symptomatology (HADS) were measured before transplant (TX) and 1 year after transplantation. Correlations between the IM scores pre transplant and SF-36 and HADS scores at follow-up were studied after controlling for baseline measures. Results: At baseline, LTX scored higher on the depression subscale, the sum-score of the HADS (P b.001, Mliver/kidney depression 7.81/6.08, Mliver/kidney sum-score 15.1/12.3) and lower on the SF-36 physical-health scale (Mliver/kidney 36.0/42.3). For the whole sample, we could not state a signi...
Distribution électronique Cairn.info pour Médecine & Hygiène. Distribution électronique Cairn.inf... more Distribution électronique Cairn.info pour Médecine & Hygiène. Distribution électronique Cairn.info pour Médecine & Hygiène. La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que dans les limites des conditions générales d'utilisation du site ou, le cas échéant, des conditions générales de la licence souscrite par votre établissement. Toute autre reproduction ou représentation, en tout ou partie, sous quelque forme et de quelque manière que ce soit, est interdite sauf accord préalable et écrit de l'éditeur, en dehors des cas prévus par la législation en vigueur en France. Il est précisé que son stockage dans une base de données est également interdit. Article disponible en ligne à l'adresse Article disponible en ligne à l'adresse https://www.cairn.info/revue-psychotherapies-2021-2-page-73.htm Découvrir le sommaire de ce numéro, suivre la revue par email, s'abonner... Flashez ce QR Code pour accéder à la page de ce numéro sur Cairn.info.
Un cas exemplaire, un cas d'ecole, un beau cas, un cas de figure, un cas extreme, un cas part... more Un cas exemplaire, un cas d'ecole, un beau cas, un cas de figure, un cas extreme, un cas particulier, un cas epineux, un cas limite ... Les modalites de l'etude de cas sont multiples et expriment le fait que tout raisonnement suivi, toute explication, toute theorie bute une fois ou l'autre sur la necessite d'explorer et d'approfondir les proprietes d'une singularite accessible a l'observation. Publier un ouvrage sur la question du cas unique, c'est participer a ce moment de reflexion sur les methodes scientifiques en psychologie. C'est aussi oeuvrer a un repositionnement constructif de cette modalite de faire science, en donnant la parole aux auteurs specialistes de ces questions ou directement concernes par celles-ci a travers leurs recherches ou leurs pratiques.
Defense mechanisms are the automatic psychological processes that mediate the individual’s reacti... more Defense mechanisms are the automatic psychological processes that mediate the individual’s reaction to emotional conflicts and internal or external stressors. So far, many classifications aim at evaluating defense mechanisms, using self-report scales, projective techniques, or clinical evaluation methods. The work Defense Mechanisms Rating Scales (DMRS) is the most used and validated instrument in the empirical study of defense mechanisms. It shows correlations between defenses and adaptive levels, between defenses and psychopathology, and it allows us to study defensive change in the course of psychoanalytic psychotherapies. The DMRS does not include psychotic defense mechanisms, a dimension that would be important to take into account in the study of severe personality disorders, bipolar disorders, paranoid patients, and patients with schizophrenic disorders. Our study group works on constructing and validating a clinical evaluation scale that includes psychotic defense mechanisms...
Dans cet article, les auteurs mettent en dialogue deux facettes des mecanismes de defense en situ... more Dans cet article, les auteurs mettent en dialogue deux facettes des mecanismes de defense en situation psychotherapeutique : la psychopathologie et le changement. Pour commencer, les instruments de mesure les plus utilises sont presentes, avec un accent sur les echelles d'evaluation par un juge externe. Les conceptions de Vaillant et de Perry sont presentees et discutees. L'article se continue avec une synthese des travaux empiriques de recherche en psychotherapie se focalisant sur les changements des mecanismes de defense au cours des psychotherapies, principalement d'orientation psychanalytique. Une reflexion autour du lien avec le concept d'alliance therapeutique, ainsi qu'avec celui du coping complete cette synthese. Des travaux recents concernant des psychotherapies de courte et de longue duree sont ensuite abordes. Les defenses sont egalement discutees du point de vue de la psychopathologie, a travers deux exemples d'etudes empiriques mettant en evidenc...
Cardiovascular diseases and dyslipidemia represent a major health issue in psychiatry. Many psych... more Cardiovascular diseases and dyslipidemia represent a major health issue in psychiatry. Many psychotropic drugs can induce a rapid and substantial increase of blood lipid levels. This study aimed to determine the potential predictive power of an early change of blood lipid levels during psychotropic treatment on long-term change and on dyslipidemia development. Data were obtained from a prospective study including 181 psychiatric patients with metabolic parameters monitored during the first year of treatment and with adherence ascertained. Blood lipid levels (ie, total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], non-high-density lipoprotein cholesterol [non-HDL-C], and fasting triglycerides [TGs]) were measured at baseline and after 1, 3, and/or 12 months of treatment. Receiver-operating characteristic analyses indicated that early (ie, after 1 month of psychotropic treatment) increases (≥5%) for TC, LDL-C, TG, and non-...
Background: Lack of adherence to medication is a trigger of graft rejection in solid-organ transp... more Background: Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients. Objective: This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal posttransplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED>20) might have lower medication adherence than noncomplex patients (INTERMED≤20). Methods: Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (>20 or ≤20). Results: Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up: one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study. Conclusion: Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics.
Long-term assessment of the effects of psychotherapy for personality disorders (PDs) in a natural... more Long-term assessment of the effects of psychotherapy for personality disorders (PDs) in a natural environment is an important task. Such research contributes to enlarge the practice-based evidence, embedded in broad collaborations between clinicians and researchers in psychotherapy for PDs. The present pilot study used rigorous assessment procedures and incorporated feedback loops of outcome information to the therapists in demonstrating the effects of psychotherapy for PD in a natural setting. The number of DSM-IV criteria for any PD was the primary outcome (along with psychological distress, depression, impulsiveness and quality of life as secondary measures), assessed at intake, 6, 12, 18 and 24 months of psychotherapy for N = 13 patients with PD. Data were analyzed using Hierarchical Linear Modeling. Results demonstrated a large prepost effect (d = 2.22) for the observer-rated measure (primary outcome), and small to medium effects for the secondary outcomes; these results were corroborated by a steady decrease of symptoms over all 5 time-points, which was significant for several outcomes. These results add a piece to the literature by demonstrating the effects of long-term psychotherapy for PDs in increasingly diverse contexts and suggest that practice-oriented research can be carried out in a collaborative and systematic manner.
Sylvie Berney et al., « L'étude des mécanismes de défense psychotiques : un outil pour la recherc... more Sylvie Berney et al., « L'étude des mécanismes de défense psychotiques : un outil pour la recherche en psychothérapie psychanalytique »,
In this review of recent therapeutic developments in psychiatry, we will report on three domains ... more In this review of recent therapeutic developments in psychiatry, we will report on three domains where new strategies have been proposed. First we will discuss the concept of neuroprotection in patients at "ultra high risk" to develop psychosis and the encouraging results of a randomised controlled trial comparing the effect of placebo and fish oil. We will then present the impact of metacognition programs which aim at adding some flexibility to thought processes used by patients with psychosis in order to reduce psychotic symptoms. We finally will report on a program of supported employment which was developed in order to help patients find an active place in society.
L’histoire de la psychiatrie et de la psychotherapie en Suisse est riche et complexe. Apres un su... more L’histoire de la psychiatrie et de la psychotherapie en Suisse est riche et complexe. Apres un survol des evenements survenus pendant la premiere moitie du XXe siecle, cet article decrit les modifications des exigences de formation pour le double titre de psychiatre et psychotherapeute FMH depuis la date de son adoption en 1961, en comparaison notamment avec la situation francaise. Les enjeux theoriques (debats d’ecoles), cliniques (integration de la psychotherapie dans les programmes de soin), scientifiques (efficacite des psychotherapies), economiques (economicite des psychotherapies), professionnels (place des medecins et des psychologues) et politiques (reconnaissance des titres et des traitements) associes a cette double formation sont esquisses.
The objective of this ongoing multicentric study is to evaluate if the INTERMED (IM), a screening... more The objective of this ongoing multicentric study is to evaluate if the INTERMED (IM), a screening instrument to assess case complexity, identifies patients at risk for unfavourable postoperative development. Methods: So far, 217 kidney (KTX) and liver (LTX) transplant patients
ObjectivesTo assess the self-reported prevalence of sexism and sexual harassment at a Swiss medic... more ObjectivesTo assess the self-reported prevalence of sexism and sexual harassment at a Swiss medical school, and to investigate their association with mental health. Research hypotheses were an association between sexism/sexual harassment and poor mental health and a higher prevalence of sexism/sexual harassment in clinical rotations.DesignCross-sectional study as a part of ETMED-L project, an ongoing cohort study of interpersonal competences and mental health of medical students.SettingSingle-centre Swiss study using an online survey submitted to medical students.ParticipantsFrom 2096 registered students, 1059 were respondents (50.52%). We excluded 26 participants (25 due to wrong answers to attention questions, and 1 who did not answer the sexism exposure question). The final sample (N=1033) included 720 women, 300 men and 13 non-binary people.MeasuresPrevalence of self-reported exposure to sexism/sexual harassment. Multivariate regression analyses of association between being targ...
Aim: The objective of this ongoing multicentric study is to evaluate if the INTERMED (IM), a scre... more Aim: The objective of this ongoing multicentric study is to evaluate if the INTERMED (IM), a screening instrument to assess case complexity, identifies patients at risk for unfavourable postoperative development. Methods: So far, 217 kidney (KTX) and liver (LTX) transplant patients were evaluated preoperatively and 70 of them at 12 months post transplant. Biopsychosocial profiles were assessed using the IM. Quality of life [Short Form 36 (SF-36)] and depressive symptomatology (HADS) were measured before transplant (TX) and 1 year after transplantation. Correlations between the IM scores pre transplant and SF-36 and HADS scores at follow-up were studied after controlling for baseline measures. Results: At baseline, LTX scored higher on the depression subscale, the sum-score of the HADS (P b.001, Mliver/kidney depression 7.81/6.08, Mliver/kidney sum-score 15.1/12.3) and lower on the SF-36 physical-health scale (Mliver/kidney 36.0/42.3). For the whole sample, we could not state a signi...
Distribution électronique Cairn.info pour Médecine & Hygiène. Distribution électronique Cairn.inf... more Distribution électronique Cairn.info pour Médecine & Hygiène. Distribution électronique Cairn.info pour Médecine & Hygiène. La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que dans les limites des conditions générales d'utilisation du site ou, le cas échéant, des conditions générales de la licence souscrite par votre établissement. Toute autre reproduction ou représentation, en tout ou partie, sous quelque forme et de quelque manière que ce soit, est interdite sauf accord préalable et écrit de l'éditeur, en dehors des cas prévus par la législation en vigueur en France. Il est précisé que son stockage dans une base de données est également interdit. Article disponible en ligne à l'adresse Article disponible en ligne à l'adresse https://www.cairn.info/revue-psychotherapies-2021-2-page-73.htm Découvrir le sommaire de ce numéro, suivre la revue par email, s'abonner... Flashez ce QR Code pour accéder à la page de ce numéro sur Cairn.info.
Un cas exemplaire, un cas d'ecole, un beau cas, un cas de figure, un cas extreme, un cas part... more Un cas exemplaire, un cas d'ecole, un beau cas, un cas de figure, un cas extreme, un cas particulier, un cas epineux, un cas limite ... Les modalites de l'etude de cas sont multiples et expriment le fait que tout raisonnement suivi, toute explication, toute theorie bute une fois ou l'autre sur la necessite d'explorer et d'approfondir les proprietes d'une singularite accessible a l'observation. Publier un ouvrage sur la question du cas unique, c'est participer a ce moment de reflexion sur les methodes scientifiques en psychologie. C'est aussi oeuvrer a un repositionnement constructif de cette modalite de faire science, en donnant la parole aux auteurs specialistes de ces questions ou directement concernes par celles-ci a travers leurs recherches ou leurs pratiques.
Defense mechanisms are the automatic psychological processes that mediate the individual’s reacti... more Defense mechanisms are the automatic psychological processes that mediate the individual’s reaction to emotional conflicts and internal or external stressors. So far, many classifications aim at evaluating defense mechanisms, using self-report scales, projective techniques, or clinical evaluation methods. The work Defense Mechanisms Rating Scales (DMRS) is the most used and validated instrument in the empirical study of defense mechanisms. It shows correlations between defenses and adaptive levels, between defenses and psychopathology, and it allows us to study defensive change in the course of psychoanalytic psychotherapies. The DMRS does not include psychotic defense mechanisms, a dimension that would be important to take into account in the study of severe personality disorders, bipolar disorders, paranoid patients, and patients with schizophrenic disorders. Our study group works on constructing and validating a clinical evaluation scale that includes psychotic defense mechanisms...
Dans cet article, les auteurs mettent en dialogue deux facettes des mecanismes de defense en situ... more Dans cet article, les auteurs mettent en dialogue deux facettes des mecanismes de defense en situation psychotherapeutique : la psychopathologie et le changement. Pour commencer, les instruments de mesure les plus utilises sont presentes, avec un accent sur les echelles d'evaluation par un juge externe. Les conceptions de Vaillant et de Perry sont presentees et discutees. L'article se continue avec une synthese des travaux empiriques de recherche en psychotherapie se focalisant sur les changements des mecanismes de defense au cours des psychotherapies, principalement d'orientation psychanalytique. Une reflexion autour du lien avec le concept d'alliance therapeutique, ainsi qu'avec celui du coping complete cette synthese. Des travaux recents concernant des psychotherapies de courte et de longue duree sont ensuite abordes. Les defenses sont egalement discutees du point de vue de la psychopathologie, a travers deux exemples d'etudes empiriques mettant en evidenc...
Cardiovascular diseases and dyslipidemia represent a major health issue in psychiatry. Many psych... more Cardiovascular diseases and dyslipidemia represent a major health issue in psychiatry. Many psychotropic drugs can induce a rapid and substantial increase of blood lipid levels. This study aimed to determine the potential predictive power of an early change of blood lipid levels during psychotropic treatment on long-term change and on dyslipidemia development. Data were obtained from a prospective study including 181 psychiatric patients with metabolic parameters monitored during the first year of treatment and with adherence ascertained. Blood lipid levels (ie, total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], non-high-density lipoprotein cholesterol [non-HDL-C], and fasting triglycerides [TGs]) were measured at baseline and after 1, 3, and/or 12 months of treatment. Receiver-operating characteristic analyses indicated that early (ie, after 1 month of psychotropic treatment) increases (≥5%) for TC, LDL-C, TG, and non-...
Background: Lack of adherence to medication is a trigger of graft rejection in solid-organ transp... more Background: Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients. Objective: This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal posttransplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED>20) might have lower medication adherence than noncomplex patients (INTERMED≤20). Methods: Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (>20 or ≤20). Results: Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up: one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study. Conclusion: Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics.
Long-term assessment of the effects of psychotherapy for personality disorders (PDs) in a natural... more Long-term assessment of the effects of psychotherapy for personality disorders (PDs) in a natural environment is an important task. Such research contributes to enlarge the practice-based evidence, embedded in broad collaborations between clinicians and researchers in psychotherapy for PDs. The present pilot study used rigorous assessment procedures and incorporated feedback loops of outcome information to the therapists in demonstrating the effects of psychotherapy for PD in a natural setting. The number of DSM-IV criteria for any PD was the primary outcome (along with psychological distress, depression, impulsiveness and quality of life as secondary measures), assessed at intake, 6, 12, 18 and 24 months of psychotherapy for N = 13 patients with PD. Data were analyzed using Hierarchical Linear Modeling. Results demonstrated a large prepost effect (d = 2.22) for the observer-rated measure (primary outcome), and small to medium effects for the secondary outcomes; these results were corroborated by a steady decrease of symptoms over all 5 time-points, which was significant for several outcomes. These results add a piece to the literature by demonstrating the effects of long-term psychotherapy for PDs in increasingly diverse contexts and suggest that practice-oriented research can be carried out in a collaborative and systematic manner.
Sylvie Berney et al., « L'étude des mécanismes de défense psychotiques : un outil pour la recherc... more Sylvie Berney et al., « L'étude des mécanismes de défense psychotiques : un outil pour la recherche en psychothérapie psychanalytique »,
In this review of recent therapeutic developments in psychiatry, we will report on three domains ... more In this review of recent therapeutic developments in psychiatry, we will report on three domains where new strategies have been proposed. First we will discuss the concept of neuroprotection in patients at "ultra high risk" to develop psychosis and the encouraging results of a randomised controlled trial comparing the effect of placebo and fish oil. We will then present the impact of metacognition programs which aim at adding some flexibility to thought processes used by patients with psychosis in order to reduce psychotic symptoms. We finally will report on a program of supported employment which was developed in order to help patients find an active place in society.
L’histoire de la psychiatrie et de la psychotherapie en Suisse est riche et complexe. Apres un su... more L’histoire de la psychiatrie et de la psychotherapie en Suisse est riche et complexe. Apres un survol des evenements survenus pendant la premiere moitie du XXe siecle, cet article decrit les modifications des exigences de formation pour le double titre de psychiatre et psychotherapeute FMH depuis la date de son adoption en 1961, en comparaison notamment avec la situation francaise. Les enjeux theoriques (debats d’ecoles), cliniques (integration de la psychotherapie dans les programmes de soin), scientifiques (efficacite des psychotherapies), economiques (economicite des psychotherapies), professionnels (place des medecins et des psychologues) et politiques (reconnaissance des titres et des traitements) associes a cette double formation sont esquisses.
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