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Sarreguemines, France

Doucet C.,University of Rennes 2 - Upper Brittany | Doucet C.,Center Hospitalier Specialise | Joubrel D.,University of Rennes 2 - Upper Brittany | Cremniter D.,Cellule durgence medico psychologique
Annales Medico-Psychologiques | Year: 2013

Objectives: Group psychological debriefings belong to the various ways of treating mental trauma. Methodological and temporal structuring of group psychological debriefings is likely to highlight subjective impacts along with the evolution of the psychodynamic functioning which has been damaged by the tragic event. This contribution presents the clinical and psychopathological analysis of twenty group psychological debriefings made by the medical and psychological emergency unit of Ile-et-Vilaine (Bretagne region, France) following sudden deaths. Method: This study goes by the 20 "intervention reports" which have been systematically written by the unit workers after each debriefing. These documents mention: the nature of the request, the number of the group psychological debriefings made for each event, the number of persons taking part of the group, the themes brought up during the debriefing development, the presence of symptoms following the event, the offer of individual consultations to some participants, the debriefing length and its subsequently possible continuation. The twenty analysed debriefings have been put in place following fourteen different events (10 suicides, three sudden deaths, an accident on the public highway), considering that several debriefings might have been organized for one same situation. The results show: © 2013.

The aim of foster care is to treat patients in a stable environment provided by foster home caregivers paid by a hospital. This mode of treatment has its distant origin in the legend of Saint Dymphna, Irish princess. This princess, exposed to the incestuous ardours of her father the king, decided to flee with her confessor, Gerebene. They landed in Flanders Geel, where she was eventually found by her father and beheaded in the public square. At the same moment an insane recovered his health. Since then, Geel became a pilgrimage for the mentally ill, who stayed there in a family for a fee. In France, the first mental health Act dates back to June 30, 1938. It required that each "department" or district has a psychiatric hospital. At the end of the xixth century, these institutions were overcrowded with chronic patients, incapable of returning to normal life. The psychiatrist August Marie created institutions then called "Family colony" to accommodate these patients. These institutions located in the Centre of France, treated as many as 1345 patients (Dun-sur-Auron) and 1145 patients (Ainay-le-Château). A new act codified this practice in 1989, defining a recruitment procedure for caregivers, specifying the facilities they should offer and the continuity of care they had to insure. Various mental hospitals then created Foster Care units. The hospitals ensuring foster care have to comply to quality controls by the High Health Authority. They offer hospitalization units for the treatment of acute psychiatric of medical episodes. Foster care thus includes these partners: a patient, a caregiver, a mental health and medical team. According to a report in 2011, 3800 patients were treated by foster care that year. The cost is estimated at the rate of 240€ per day, much lower than traditional hospital treatment, but with a better quality of life for beneficiaries. © 2013.

Which are the guidelines and scientific aspects for repackaged oral solid medications in France in 2010 whereas it develops? The transient or definitive displacement of the solid oral form from the original atmosphere to enter a repackaging process, sometimes automated, is likely to play a primary role in the controversy. However, the solid oral dose is to be repackaged in materials with defined quality. Considering these data, a review of the literature for determination of conditions for repackaged drug stability according to different international guidelines is presented in this paper. Attention is also paid to the defined conditions ensuring the conservation and handling of theses drugs throughout the repackaging process. However, there is lack of scientific published stability data. Nevertheless, recent alternatives may be proposed to overcome the complexity of studying stability in such conditions. Then, the comparison of the moisture barrier properties of the respective package, a galenic model of hygroscopic molecules, or light sensitive molecules or stability data obtained during the industrial preformulation phase could also secure the list of drugs to be reconditioned. Similarly, a wise precaution will be to get stability data for the industrial blisters and unit doses undergoing the real conditions of the medication use process in hospitals and other healthcare settings. By now, reduction of dispensing errors and improvement of the compliance aid put a different perspective on the problem of repackaged drugs. To date, the pharmacist is advised to carry out its analysis of the risks. © 2010 Elsevier Masson SAS.

Introduction: The act of June 17, 1998 created a new form of compulsory treatment: the injunction to care. This is a legal measure intended to fight against recidivism of offenders and sex offenders through medical measures. The only therapies that have demonstrated partial efficacy are cognitive behavioural therapy and treatment with anti-hormone. In France, psychodynamic therapies are paramount in the treatment of perpetrators of sexual violence, although such treatments have not demonstrated effectiveness in reducing sexual recidivism. Very few studies are available regarding the implementation of court-ordered treatment in France. The recent report by the General Inspectorate of Social Affairs (IGAS) in 2011 confirms the absence of medical statistics on the implementation of court-ordered care. Objective: We conducted a study on the procedure of the injunction to care in the regions of Alsace and Lorraine. The aim of the study is to develop an inventory coordinator for practitioners (number, type of exercise) and the profile of patients undergoing the injunction of care (type of offense convicted for, psychiatric comorbidity identified for example). Methods: We first identified the practicing coordinator doctors by contacting the High Courts in the geographic area studied. We then sent out a questionnaire by post to coordinator doctors to profile their patients on care injunctions. Results: We identified 16 practicing coordinator doctors in two study areas: 13 are state hospital doctors and three are private practice. Of the 16 doctors contacted, six returned the completed questionnaires (38% of the sample). This allows characterizing a sample of 50 patients on care injunctions. The majority of convicted crimes are of a sexual nature (92% of cases). This is mostly for crimes or sexual offenses involving minors aged under 15 (83% of cases). Psychiatric comorbidity is the most frequently identified paedophile primary (38%) followed by mental retardation (14%), dissocial personality disorder (6%) and a borderline personality, and emotional liability (6%). Other comorbidities are divided between paranoid schizophrenia, chronic alcoholism, or other personality disorder. The follow-up is monitored by a physician in 82% of cases, while it is provided by a psychologist in 18% of cases. The management consists of a simple psychotherapy in 66% of cases. Pharmacological treatment is most often prescribed with antipsychotics (26% of cases), followed by anti-depressants (4%) and the anti-hormone (4%). Conclusion: Our study confirms that the majority of patients on care injunctions are sexual offenders involving minors under the age of 15. The most implemented treatment is a simple psychotherapy. The pharmacological option is infrequent and generally involves the use of inappropriate treatment (neuroleptics). Suppressive libido treatment (antidepressants and anti hormone) remains an exception in France. © 2013 L'Encéphale, Paris.

Since the Act of June 17, 1998, the practice of assessment has changed from a psychiatric assessment of liability to an estimate of risk of recurrence in post sentencing. If the psychiatric examination is designed to address the issue of good judgement in pre-sentencing, what about the situation in post-sentencing? Is a basic clinical reading sufficient for a question concerning criminology? This article reviews the various factors identified as associated with a risk of recurrence of violent behaviour. It concerns issues arising from criminology studies, and validated internationally. The identification of these factors should answer at least, in part, the question of the magistrate: "estimate the risk of recurrence," a key issue in so-called post-sentencing expertise.

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