Sante Mentale au Quebec最新文献

{"title":"[Mentalization of conflicts in group therapy: Destructivity and survival in the benefit of cohesion].","authors":"J. Cherrier, A. Francisco, François-Samuel Lahaie","doi":"10.7202/1098899ar","DOIUrl":"https://doi.org/10.7202/1098899ar","url":null,"abstract":"The high prevalence of personality disorders, along with their substantial functional impact, are important societal issues, which must be addressed by mental health services. Many treatments have shown significant benefits and have contributed to alleviate the difficulties tied to these disorders. Mentalization-based therapy (MBT), which is constituted of a group therapy modality, is an evidence-based treatment of borderline personality disorder. The mentalization-based group therapy (MBT-G) modality raises many challenges for the psychotherapists. The effectiveness of the group intervention lies, according to the authors, in the capacity to support the mentalizing stance, to stimulate group cohesion, and allows the experience of a healthy and healing process of reappropriation of conflictual situations, situations which, in their opinion, are underutilized in this type of therapeutic process. This article focuses on the interventions that foster a mentalizing attitude. Specifically, we discuss how to focus on the \"here and now,\" how to identify and resolve conflictual situations and how to enhance metacognitions and, hence, group cohesion, while aiming to bonify the therapeutic process.","PeriodicalId":44148,"journal":{"name":"Sante Mentale au Quebec","volume":"81 1","pages":"165-174"},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80116813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Therapeutic measures under Swiss criminal law: Little treatment, long-term control and strong obsession with public security].","authors":"Nicolas Queloz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Objectives This article aims at a critical study of the evolution of therapeutic measures in Swiss criminal law and of the ambiguous role that criminal justice let play to legal psychiatry in its decisions. Swiss law defines as criminal sanctions both sentences (punishment) and measures. Among the latter, a distinction must be drawn between therapeutic measures, aiming in principle at the treatment of the convicted person, and security measures, designed essentially to protect public security. Method To this end, after a brief presentation of the history of penal treatment measures in Switzerland, the status of measures in the criminal sanctions system is examined, presenting the range of different criminal measures and their evolution in time. Then, the relationship between mental health and justice, in particular the question of institutional treatment of mental disordered delinquents is analyzed, including the criticisms that it raises. Results The development of criminal measures over the last twenty years is characterized by two general trends: a strong decrease in the total number of criminal measures which have been ordered, and a sharp increase in the number of institutional therapeutic measures (Art. 59 CPS) to which offenders with serious mental disorders have been convicted. This latter increase is in line with a Swiss criminal security policy that is becoming more and more oriented towards risk management and marked by an obsession with the control of \"high-risk offenders.\" In this logic, the primary aim of treatment for these offenders is supplanted by the aim of the protection of public security. This assumption is particularly tangible since therapeutic measures are not subject to a specific time limit and can be - and in practice are - regularly extended. This obsession with security is also crystallized in the difficult interaction between the judicial and the psychiatric worlds, since expertise is required for the pronouncement and the extension of a criminal measure. The system is criticized as well under a psychiatric as under a juridical point of view, and certain aspects have been recently condemned by the European Court of Human Rights. Conclusion We can observe that the use of the institutional therapeutic measure has increased, yet departing from its initial purpose, and obeying the movement towards more public security, even though the pronouncement of this measure is open to criticism. It rarely achieves its therapeutic objective, it is regularly submitted to prolongation, and it can lead to a measure of internment or a custodial sentence pronounced jointly, which run counter to the concrete needs of a person with mental health problems.</p>","PeriodicalId":44148,"journal":{"name":"Sante Mentale au Quebec","volume":"47 1","pages":"129-149"},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10419886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Insomnia and suicide risk in cluster B personality disorder: A comparative cross-sectional study].","authors":"Magali Tisseyre,&nbsp;Alexandre Hudon,&nbsp;Charles-Édouard Giguère,&nbsp;Annie Vallières,&nbsp;Célyne Bastien,&nbsp;Félix-Antoine Bérubé,&nbsp;Lionel Cailhol","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Objective The suicide mortality rate among people suffering from cluster B personality disorders is estimated at approximately 20%. High occurrence of comorbid depression and anxiety, as well as substance abuse, are known contributors to this risk. Not only have recent studies indicated that insomnia may be a suicide risk factor, but it is also thought to be highly prevalent in this clinical group. However, the mechanisms explaining this association are still unknown. It has been suggested that emotion dysregulation and impulsivity may mediate the link between insomnia and suicide. In order to better understand the association between insomnia and suicide in cluster B personality disorders, it is important to consider the influence of comorbidities. The aims of this study were first to compare the levels of insomnia symptoms and impulsivity between a group of patients with cluster B personality disorder and a healthy control group and second, to measure the relationships between insomnia, impulsivity, anxiety, depression, substance abuse and suicide risk within the cluster B personality disorder sample. Methods Cross-sectional study including 138 patients (mean age = 33.74; 58.7% women) with cluster B personality disorder. Data from this group were extracted from a Quebec-based mental health institution database (Signature bank: www.banquesignature.ca) and were compared to that of 125 healthy subjects matched for age and sex, with no history of personality disorder. Patient diagnosis was determined by diagnostic interview upon admission to a psychiatric emergency service. Anxiety, depression, impulsivity and substance abuse were also assessed at that time point via self-administered questionnaires. Participants from the control group visited the Signature center to complete the questionnaires. A correlation matrix and multiple linear regression models were used to explore relations between variables. Results In general, more severe insomnia symptoms and higher levels of impulsivity distinguished the group of patients with cluster B personality from the sample of healthy subjects, although groups did not differ on total sleep time. When all variables were included as predictors in a linear regression model to estimate suicide risk, subjective sleep quality, lack of premeditation, positive urgency, depression level and substance use were significantly associated with higher scores on the Suicidal Questionnaire-Revised (SBQ-R). The model explained 46.7% of the variance of scores at the SBQ-R. Conclusion This study yields preliminary evidence indicating the possible implication of insomnia and impulsivity in suicide risk for individuals with cluster B personality disorder. It is proposed that this association seems to be independent of comorbidity and substance use levels. Future studies may shed light on the possible clinical relevance of addressing insomnia and impulsivity in this clinical population.</p>","PeriodicalId":44148,"journal":{"name":"Sante Mentale au Quebec","volume":"47 2","pages":"113-139"},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9644532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La propension à la honte dans le trouble de personnalité limite : réflexion critique à partir de données québécoises","authors":"David Théberge, Dominick Gamache, Sébastien Hétu, Julie Maheux, C. Savard","doi":"10.7202/1098896ar","DOIUrl":"https://doi.org/10.7202/1098896ar","url":null,"abstract":"","PeriodicalId":44148,"journal":{"name":"Sante Mentale au Quebec","volume":"168 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71266914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Les mesures thérapeutiques en droit pénal suisse","authors":"N. Queloz","doi":"10.7202/1094148ar","DOIUrl":"https://doi.org/10.7202/1094148ar","url":null,"abstract":"résumé Objectifs En droit suisse, les sanctions pénales comprennent les peines et les mesures. Parmi ces dernières, il faut distinguer les mesures thérapeutiques, destinées en principe au traitement de la personne condamnée, des mesures sécuritaires qui visent prioritairement à protéger la sécurité publique. Les objectifs de cet article sont de porter un regard critique sur l’évolution du prononcé des mesures d’enfermement « thérapeutique » en Suisse et sur le rôle ambigu que la justice pénale fait jouer à la psychiatrie légale dans ses prises de décision.","PeriodicalId":44148,"journal":{"name":"Sante Mentale au Quebec","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71255371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Le Modèle de prévention de l’utilisation des mesures de contrôle en santé mentale : une revue intégrative","authors":"Marie-Hélène Goulet, Clara Lessard-Deschênes","doi":"10.7202/1094149ar","DOIUrl":"https://doi.org/10.7202/1094149ar","url":null,"abstract":"résumé Contexte Les mesures de contrôle en santé mentale, telles que l’isole ment et la contention, sont encore utilisées fréquemment malgré les effets néfastes qui leur sont associés et qui sont bien documentés. Dans ce contexte, la réduction du recours à ces mesures est un objectif partagé au niveau international, suscitant de nombreuses études à cet égard. Bien que plusieurs interventions préventives se montrent efficaces","PeriodicalId":44148,"journal":{"name":"Sante Mentale au Quebec","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71255547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mother suffering from borderline personality disorder: Which specific care in the periodal period? A literature review].","authors":"Audrey Serrano,&nbsp;Emmanuelle Teissier,&nbsp;Ludivine Guerin Franchitto,&nbsp;Alexis Revet,&nbsp;Jean-Philippe Raynaud,&nbsp;Lionel Cailhol","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Borderline personality disorder (BPD) is a common and severe disorder characterized by unstability of self-image, unstable affect, and unstable interpersonal relationships. Women with BPD would give birth as much as other women, but according to several studies, BPD mothers have a reduced sensitivity to their babies and a poor interpretation of their emotions; this would interfere in mother-baby interaction and in psycho-affective development of the baby, with the risk to develop psychiatric pathologies in adulthood. In this context several professionals have developed different interventions for mothers suffering from BPD. Objectives The main objective of this literature review is to list the interventions developed for BPD mothers during the perinatal period (from pregnancy to the 18 months of infant). The secondary objective is to assess the effectiveness of some of these interventions. Method We have screened five databases: PUBMED/MEDLINE, EMBASE, CINAHL, EBM REVIEWS and PSYCINFO, gray literature, recommendations of some countries, Google.ca website and OpenGray. We used keywords to screen the articles: Borderline personality disorder; Mothers, Women, Woman, Maternal, Perinatal, Perinatology, Postnatal, Postpartum, Pregnant, Pregnancy(ies), Infant(s), Infancy, Baby(ies), Newborn(s), Offspring(s), Young child, Young children. To be included, an article had to be written in English or French and published between 1980 and 2020 (a bibliographic watch was then carried out until December 2021); it had to deal with preventive and/or therapeutic intervention(s) targeting mothers suffering from BPD in the perinatal period. Results The search have generated 493 articles and 20 articles were selected. We have identified two main types of interventions: some are centered on the mother-baby dyad, others are centered only on the mother. Among them, there are therapies established for BPD patients in the general population, or specific mother-baby psychotherapies. Interventions are multidisciplinary, intervene early and intensively. Four articles have analysed the effectiveness of their program: according to the studies, the beneficial effects on dyadic interactions generally appear after several weeks of treatment, and for some programs the effects may persist over time; three authors show a reduction of maternal depressive symptoms. Only Australia and Switzerland have published recommendations targeting BPD mothers in the perinatal period. Conclusion Interventions with BPD mothers in the perinatal period can be based on reflexives theoreticals models or be in connection with the emotional dysregulation from which these mothers suffer. They must be early, intensive and multi-professional. Given the lack of studies that have analysed the efficacy of their programs, no intervention currently stands out, so it seems important to continue the investigations.</p>","PeriodicalId":44148,"journal":{"name":"Sante Mentale au Quebec","volume":"47 2","pages":"235-267"},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9644531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Validation of a screening procedure for borderline personality disorder based on the Alternative DSM-5 Model for Personality Disorders].","authors":"Dominick Gamache,&nbsp;Claudia Savard,&nbsp;Maude Payant,&nbsp;Philippe Leclerc,&nbsp;Renée-Claude Dompierre,&nbsp;David Roy,&nbsp;Marc Tremblay,&nbsp;Mélissa Verreault,&nbsp;Évens Villeneuve","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Objectives The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes an Alternative Model for Personality Disorders (DSM-5), which defines personality disorders based on two dimensional criteria. Criterion A corresponds to the severity of personality dysfunction in the areas of self and interpersonal functioning, while Criterion B comprises five pathological domains including a total of 25 facets. Six specific disorders, including borderline personality disorder (BPD), are defined in the AMPD based on Criteria A and B. However, there is currently very little data on these diagnoses as they are operationalized in the MATP. This study aims to present data on this recent operationalization of BPD. More specifically, we will first introduce a procedure, based on self-reported questionnaires covering the two main MATP criteria, implemented to generate the BPD diagnosis from the AMPD. Then, we will assess its validity (a) by documenting its prevalence in a clinical sample; (b) by determining its degree of correspondence with the \"traditional\" BPD categorical diagnosis and with a dimensional measure of borderline symptomatology; (c) by presenting convergent validity data with constructs relevant to the study of BPD (impulsivity, aggression); and (d) by determining the incremental validity of the proposed procedure in contrast with a simplified approach where only Criterion B would be considered. Method Data from 287 patients recruited as part of the admission process at the Centre de traitement le Faubourg Saint-Jean of the CIUSSS-Capitale-Nationale were analyzed. The BPD diagnosis from the MATP was generated based on two validated self-report questionnaires, in their French version, namely the Self and Interpersonal Functioning Scale (Criterion A) and the Personality Inventory for DSM-5-Faceted Brief Form (Criterion B). Results The BPD diagnosis, as operationalized in the AMPD, had a prevalence of 39.7% in the sample. A moderate fit with the clinician's diagnosis of BPD according to the traditional DSM-5 categorical model was observed, as well as a strong correlation with a dimensional measure of borderline symptomatology. Nomological network analysis revealed high and theoretically expected correlations between the disorder and measures of aggression and impulsivity. The proposed diagnostic extraction procedure, which uses Criteria A and B, showed incremental validity in the statistical prediction of external variables (borderline symptomatology, aggression, impulsivity) compared to a simplified procedure using only Criterion B. Conclusions The proposed procedure for generating the BPD diagnosis according to the MATP definition yields promising results and could allow screening for the disorder based on this contemporary conceptualization of personality pathologies.</p>","PeriodicalId":44148,"journal":{"name":"Sante Mentale au Quebec","volume":"47 2","pages":"17-39"},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9946664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mentalization of conflicts in group therapy: Destructivity and survival in the benefit of cohesion].","authors":"Jean-François Cherrier,&nbsp;Alexandre Francisco,&nbsp;François-Samuel Lahaie","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The high prevalence of personality disorders, along with their substantial functional impact, are important societal issues, which must be addressed by mental health services. Many treatments have shown significant benefits and have contributed to alleviate the difficulties tied to these disorders. Mentalization-based therapy (MBT), which is constituted of a group therapy modality, is an evidence-based treatment of borderline personality disorder. The mentalization-based group therapy (MBT-G) modality raises many challenges for the psychotherapists. The effectiveness of the group intervention lies, according to the authors, in the capacity to support the mentalizing stance, to stimulate group cohesion, and allows the experience of a healthy and healing process of reappropriation of conflictual situations, situations which, in their opinion, are underutilized in this type of therapeutic process. This article focuses on the interventions that foster a mentalizing attitude. Specifically, we discuss how to focus on the \"here and now,\" how to identify and resolve conflictual situations and how to enhance metacognitions and, hence, group cohesion, while aiming to bonify the therapeutic process.</p>","PeriodicalId":44148,"journal":{"name":"Sante Mentale au Quebec","volume":"47 2","pages":"165-174"},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9946665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Crisis-MBT: Mentalization-based brief hospitalization intervention].","authors":"Christian Greiner,&nbsp;Martin Debbané,&nbsp;Vincent Besch,&nbsp;Paco Prada","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Context Our team works in a psychiatric hospital unit at the University Hospitals of Geneva (Switzerland). We welcome there for 7 days people in crisis situations who have either suicidal thoughts or suicidal behavior. As factors precipitating the suicidal crisis, these people go through life events that are accompanied by intense interpersonal difficulties or that threaten the image they have of themselves. In our clinical population, approximately 35% of patients suffer from borderline personality disorder (BPD). In these patients, repeated crises and suicidal behavior lead to frequent and damaging relational and therapeutic ruptures. Our objective is to develop a specific approach to this clinical problem. Intervention We have developed a brief psychological intervention informed by mentalization-based treatment (MBT) in 4 stages: welcoming of the patient, affective mentalization of the crisis elements, formulation of the problem, work on discharge and the continuation of outpatient care. This intervention is suitable for a medical-nursing team. From a MBT point of view, the welcoming phase is mainly devoted to mirroring and affective regulation in order to reduce the intensity of psychic disorganization. It is then a question of activating the capacity to mentalize, namely curiosity about mental states, through work on the crisis narrative with an affective focus. We then work with people to construct a formulation of their problem in which they can assume a role. It is about making them \"agents\" of their crises. Then we can end the intervention by working on both the separation and a projection into the immediate future. The goal is then to extend the psychological work started in our unit at the level of an ambulatory network. The termination phase sees the attachment system reactivated and the reappearance of the difficulties hitherto outside the therapeutic space. Clinical implications MBT is effective for BPD, particularly in reducing suicidal gestures and the number of hospitalizations. We have adjusted its theoretical and clinical device for individuals hospitalized due to a suicidal crisis and who present various and comorbid psychopathological profiles. MBT allows the adaptation and evaluation of empirically based psychotherapeutic tools to different clinical settings but also to different clinical populations.</p>","PeriodicalId":44148,"journal":{"name":"Sante Mentale au Quebec","volume":"47 2","pages":"221-233"},"PeriodicalIF":0.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9946670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}