2 years' review of pediatric emergencies admitted in the resuscitation room of a Swiss university hospital

Introduction: Paediatric resuscitation is an intense, stressful andchallenging process performed in a specific surrounding. In theresuscitation room (RR), a dedicated pediatric team is not alwaysavailable and its composition varies according to local resources. Aregular review of the children admitted in the resuscitation room andthe assessment of various outcome measures are the basis of qualitycontrol (QC). The epidemiology of Potentially Life ThreateningPaediatric (LTP) emergencies admitted in a Swiss university hospitalhas never been reported. The aims of this study were to review theLTP emergency population with regards to origin, patients'demographics, reason for admission and final diagnosis, treatmentmodalities, critical events and outcome.Methods: A retrospective observational cohort study of prospectivelycollected data was conducted, including all LTP emergencies admittedover a period of 2 years in the RR of a Swiss university hospitalfunctioning as a tertiary level referral centre. Multiple variablesincluding indication for transfer, mode of pre-hospital transportation,diagnosis and the time spent in RR were assessed. Data assessmenttook place 2 years after the implementation of a quality control (QC)team assessing the pediatric resuscitations occurring within theinstitution on a monthly basis.Results: Out of 60 939 pediatric emergencies treated in LausanneUniversity Medical center over 2 years, a total of 277 LTP emergencies(0.46%) were admitted to the RR, including 160 boys and 117 girls,aged 6 days to 15.95 years (mean 6.69 years, median 5.06). The tablebelow illustrates in more details the identified problems, average age,time in hospital and outcome of both surgical and medical groups ofpatients.Conclusions: With the need for health care quality improvement andfinancial restrictions, an excellent knowledge of the characteristics ofLTP emergencies is unavoidable. A thorough understanding of theresuscitation process and humans resources involved can be achievedwith a systematic review of the cases. A dedicated quality control teamevaluating LTP emergencies in a hospital will identify areas forimprovement. A LTP registry at the national level would be of greatvalue in Switzerland.

Dépersonnalisation. Données actuelles.

OBJECTIVE: Depersonalization is a fascinating clinical phenomenon referring to a self-consciousness disorder, characterized by emotional detachment from one's own feelings, thoughts, or actions. This article intends to summarize the current literature in this area. METHOD: Using the Medline data base, we reviewed literature addressing the clinical, etiology, nosology, physiopathology, and treatment of depersonalization. CONCLUSIONS: Derealization means that perception of the world and of external reality are altered. These 2 phenomena are often associated. They are not specific to any psychiatric entity and are reported in many different psychiatric syndromes. Many factors, including use of different substances, are involved in their onset. The physiopathology is still little known. However, some conceptual models suggest partial amygdala inhibition combined with activation of other amygdaloid structures. A serotoninergic functioning impairment is indicated in different pharmacologic studies. Different psychotropic drugs, especially serotoninergic antidepressants, have been proposed for pharmacotherapy; however, there are no conclusive randomized studies, and the contribution of psychotherapy in treating these patients is still questioned

Religion in Times of Crisis

Religion is alive and well all over the world, especially in times of personal, political, and social crisis. Even in Europe, long regarded the most "secular" continent, religion has taken centre stage in how people respond to the crises associated with modernity, or how they interact with the nation-state. In this book, scholars working in and on Europe offer fresh perspectives on how religion provides answers to existential crisis, how crisis increases the salience of religious identities and cultural polarization, and how religion is contributing to changes in the modern world in Europe and beyond. Cases from Poland to Pakistan and from Ireland to Zimbabwe, among others, demonstrate the complexity and ambivalence of religion's role in the contemporary world.

Specificities of defense mechanisms in bipolar affective disorder: relations with symptoms and therapeutic alliance.

Defense mechanisms as a central notion of psychoanalysis have inspired various levels of interest in research in psychotherapy and psychopathology. Defense specificities have only recently been investigated systematically with regard to several clinical diagnoses, such as affective and personality disorders. For the present study, 30 inpatients diagnosed with Bipolar Affective Disorder I (BD) were interviewed. An observer-rater method, the Defense Mechanisms Rating Scales (DMRS), applied to session-transcripts, of assessment of defenses was used. A matched, nonclinical control group was introduced. Defense specificities in BD encompass a set of 5 immature defenses, of which omnipotence is linked with symptom level. The level of the therapeutic alliance is predicted by mature defenses. These results are discussed with regard to the psychological vulnerability of BD, and treatment implications for psychodynamic psychotherapy with such challenging patients are evoked.

Psychiatrie [Psychiatry]

In 2008 there is no major breakthrough in the field of psychopharmacology. Paliperidone, (Invega), or 9-hydroxyrisperidone, the main hydroxylated metabolite of risperidone, is now available in Switzerland. It has the same pharmacodynamic profile and a different pharmacokinetic profile, linked to an extended release preparation. Bupropion, an antidepressant with noradrenergic and dopaminergic activity, is now accepted on the Swiss market for the treatment of depression under the name of Wellbutrin. Until now, its indication was limited to tobacco withdrawal (under the name of Zyban). The article also includes new data issued from the STAR*D study (concerning the efficacy of cognitive behavioural therapy) and a few remarks about the recent debate in the media about the efficacy of antidepressants.

Suivi neurodéveloppemental à 5ans des extrêmes prématurés et détection des difficultés sur le plan des fonctions exécutives [Detection of executive function disorders with a standard neurodevelopmental follow-up of premature children].

INTRODUCTION: A significant proportion of prematurely born children encounter behavioral difficulties, such as attention deficit or hyperactivity, which could be due to executive function disorders. AIMS: To examine whether the standard neurodevelopmental assessment offered to premature children in Switzerland recognizes executive function disorders. METHODS: The study population consisted of 49 children born before 29 weeks of gestation who were examined between 5 and 6 years of age with a standard assessment, with additional items to assess executive functioning. Children with severe neurodevelopmental impairment were excluded (mental retardation, cerebral palsy, autism). Standard assessment consisted in the Kaufman Assessment Battery for Children (K-ABC), which comprises three subscales: sequential processes (analysis of sequential information), simultaneous processes (global analysis of visual information), and composite mental processes (CMP) (result of the other two scales), as well as a behavioral evaluation using the standardized Strengths and Difficulties Questionnaire (SDQ). Executive functioning was assessed with tasks evaluating visual attention, divided attention, and digit memory as well as with a specialized questionnaire, the Behavior Rating Index of Executive Functions (BRIEF), which evaluates several aspects of executive function (regulation, attention, flexibility, working memory, etc). RESULTS: Children were divided according to their results on the three K-ABC scales (< or>85), and the different neuropsychological tasks assessing executive function were compared between the groups. The CMP did not differentiate children with executive difficulties, whereas a score<85 on the sequential processes was significantly associated with worse visual and divided attention. There was a strong correlation between the SDQ and the BRIEF questionnaires. For both questionnaires, children receiving psychotherapy had significantly higher results. Children who presented behavioral problems assessed with the SDQ presented significantly higher scores on the BRIEF. CONCLUSION: A detailed analysis of the standard neurodevelopmental assessment allows the identification of executive function disorders in premature children. Children who performed below 85 on the sequential processes of the K-ABC had significantly more attentional difficulties on the neuropsychological tasks and therefore have to be recognized and carefully followed. Emotional regulation had a strong correlation with behavioral difficulties, which were suitably assessed with the SDQ, recognized by the families, and treated.

What interventions facilitate client progress through the assimilation model? A task analysis of interventions in the psychodynamic treatment of depression.

A variation of task analysis was used to build an empirical model of how therapists may facilitate client assimilation process, described in the Assimilation of Problematic Experiences Scale. A rational model was specified and considered in light of an analysis of therapist in-session performances (N = 117) drawn from six inpatient therapies for depression. The therapist interventions were measured by the Comprehensive Psychotherapeutic Interventions Rating Scale. Consistent with the rational model, confronting interventions were particularly useful in helping clients elaborate insight. However, rather than there being a small number of progress-related interventions at lower levels of assimilation, therapists' use of interventions was broader than hypothesized and drew from a wide range of therapeutic approaches. Concerning the higher levels of assimilation, there was insufficient data to allow an analysis of the therapist's progress-related interventions.

Responsiveness et changement thérapeutique au travers de l'études de cas

Le concept de responsiveness ou « responsivité » a été proposé dans le domaine de la recherche en psychothérapie pour décrire l'influence mutuelle qui s'exerce continuellement entre patient et thérapeute. La nature responsive des psychothérapies pose alors un problème majeur aux chercheurs, qui adoptent généralement des plans de recherche impliquant des liens de cause à effet et sont en échec dans leur entreprise de mieux comprendre le changement thérapeutique. L'objectif de notre travail est de proposer des pistes pour répondre à ce problème. Nous avons adopté la méthode d'étude de cas, qui permet une analyse en profondeur et en contexte des processus de changement. Dans les deux premières phases de la recherche, nous nous situions dans une approche spécifique à la recherche qualitative en psychothérapie. Nous avons tout d'abord analysé comment le changement s'effectuait chez le patient, en identifiant pas à pas le niveau d'assimilation de ses expériences problématiques. Nous avons ensuite tenté d'appréhender le rôle du thérapeute dans le processus de changement. Notre objectif était d'analyser comment la responsivité du thérapeute pouvait faciliter le processus de changement chez le patient à chaque instant de la thérapie. En suivant une procédure inspirée de l'analyse de la tâche, nous avons identifié pour chaque niveau d'assimilation des interventions thérapeutiques suivies de progression, et élaboré un modèle empirique séquentiel. Dans la troisième phase de la recherche, nous avons effectué un tournant dans notre parcours et sommes allée du côté des sciences du langage. En adoptant une approche dialogique du discours, notre objectif était d'éclairer notre objet d'étude à partir d'une nouvelle perspective et d'ouvrir la réflexion. Nous avons ainsi pu répondre à certaines limites rencontrées dans les premières phases de la recherche, et faire émerger de nouvelles questions et perspectives pour l'étude des processus de changement dans une dimension interactive. -- The concept of responsiveness was developed in psychotherapy research to describe the mutual and constant influence between patient and therapist. The responsive nature of psychotherapy is a serious problem for researchers, who generally adopt research designs involving cause-effect reasoning and fail to better understand therapeutic change. The purpose of our work is to propose some viable possibilities to respond to this problem. We chose the case study method, which enables an analysis in depth and in context of change processes. In the two first phases of research, our approach was specific to qualitative psychotherapy research. We first analyzed how change occurred in the patient, by identifying moment-by-moment the level of assimilation of his or her problematic experiences. We then tried to apprehend the therapist role in the change process. Our aim was to analyze how the therapist responsiveness could facilitate the patient change process at any moment of psychotherapy. We followed a procedure inspired by task analysis and, for each level of assimilation, we identified therapist interventions followed by progression, and elaborated an empirical sequential model. The third phase of research was a turning point, as we went in the field of linguistics. We adopted a dialogical approach of discourse to open up reflection. Thus, we could answer some limitations encountered in the first phases of research, and new questions and perspectives to study change process taking into account the interactive dimension emerged.

Mise en récit et théâtralisation dans le jeu en psychothérapie d'enfants : de l'archaïque au symbolique

« Il était une fois... Cette thèse aborde le lien entre l'expression théâtrale et son utilisation clinique dans la psychothérapie d'enfants. Partant du questionnement sur les origines du théâtre et de la thérapie dans l'histoire de l'humanité, donc du substrat « archaïque » de l'homme et de sa relation à l'art scénique, la première partie développe une réflexion autour des rituels, du chamanisme et de la notion du soin. Purement théorique, elle soulève cependant la question de l'identité de l'Homme dans les sociétés postmodernes et traite de la thématique du développement psychique de l'enfant au sein de notre société occidentale ainsi que des souffrances qui en amènent certains vers les consultations psychologiques La partie principale s'articule autour de six histoires cliniques d'enfants suivis en psychothérapie expressive, récits dans lesquels la médiation théâtrale et corporelle devient 1 outil central du soin. En se développant sur la base d'une mise en narration des histoires imaginaires des enfants qui reflètent leurs angoisses archaïques, 1 univers thérapeutique prend alors la forme d'une scène psychique ouvrant a la symbolisation à travers le jeu théâtral. Parallèlement à la description de ce dispositif, une élaboration est menée autour des échanges transférentiels et con re transferentiels ainsi que sur la position du thérapeute - son rôle de « médium malleable » - dans la relation à l'Autre qui se tisse dans un « ici et maintenant » de la rencontre psychotherapeutic. Grâce à cet univers ludique s'enracinant dans son vécu psycho-fantasmatique, l'enfant devient l'acteur agissant de sa propre transfonnation : une évolution du monstre archaïque en sa créature symbolique. -- « Once upon a time... » This thesis treats the link between theatrical expression and its clinical use in children s psychotherapy. Originating from interrogations on the origins of theatre and therapy in the history of mankind, therefore the « archaic » substratum of Man and his relation to the theatre. The first part develops a reflection around rituals shamanism and the notion of care. In a purely theoretical way, it brings up the ques ions of Man's identity in post-modern societies and deals with the psychic development of children in western society and the pains that lead some to seek for psychological consultations. The main part hinges on six clinical stories of children in expressive psychotherapy, m which theatrical and coiporal mediation become the main tool within he treatment. By putting into narration, the children's imaginary stories that reflect their archaic anxiety, therapy takes in the shape of a psychic scene, which opens to symbolization through acting. At the same time, an elaboration is lead on transferential and counter-transferential exchanges as on the therapists position - his role as « malleable medium » - his interactions with others as a «here and now » in the psychotherapeutic encounter. Thanks to this playful universe, which emerges from his psycho-fantasy past, the child becomes the willing actor of his own transformation: the evolution of the archaic monster into its symbolical creature.

A thematic analysis of delusion with religious content in schizophrenia: open, closed, and mixed dynamics

The aim of the present study was to elicit how patients with delusions with religious contents conceptualized or experienced their spirituality and religiousness. Sixty-two patients with present or past religious delusions went through semistructured interviews, which were analyzed using the three coding steps described in the grounded theory. Three major themes were found in religious delusions: ''spiritual identity,'' ''meaning of illness,'' and ''spiritual figures.'' One higher-order concept was found: ''structure of beliefs.'' We identified dynamics that put these personal beliefs into a constant reconstruction through interaction with the world and others (i.e., open dynamics) and conversely structural dynamics that created a complete rupture with the surrounding world and others (i.e., closed structural dynamics); those dynamics may coexist. These analyses may help to identify psychological functions of delusions with religious content and, therefore, to better conceptualize interventions when dealing with it in psychotherapy.

Acute Effects of Lysergic Acid Diethylamide in Healthy Subjects.

BACKGROUND: After no research in humans for >40 years, there is renewed interest in using lysergic acid diethylamide (LSD) in clinical psychiatric research and practice. There are no modern studies on the subjective and autonomic effects of LSD, and its endocrine effects are unknown. In animals, LSD disrupts prepulse inhibition (PPI) of the acoustic startle response, and patients with schizophrenia exhibit similar impairments in PPI. However, no data are available on the effects of LSD on PPI in humans. METHODS: In a double-blind, randomized, placebo-controlled, crossover study, LSD (200 μg) and placebo were administered to 16 healthy subjects (8 women, 8 men). Outcome measures included psychometric scales; investigator ratings; PPI of the acoustic startle response; and autonomic, endocrine, and adverse effects. RESULTS: Administration of LSD to healthy subjects produced pronounced alterations in waking consciousness that lasted 12 hours. The predominant effects induced by LSD included visual hallucinations, audiovisual synesthesia, and positively experienced derealization and depersonalization phenomena. Subjective well-being, happiness, closeness to others, openness, and trust were increased by LSD. Compared with placebo, LSD decreased PPI. LSD significantly increased blood pressure, heart rate, body temperature, pupil size, plasma cortisol, prolactin, oxytocin, and epinephrine. Adverse effects produced by LSD completely subsided within 72 hours. No severe acute adverse effects were observed. CONCLUSIONS: In addition to marked hallucinogenic effects, LSD exerts methylenedioxymethamphetamine-like empathogenic mood effects that may be useful in psychotherapy. LSD altered sensorimotor gating in a human model of psychosis, supporting the use of LSD in translational psychiatric research. In a controlled clinical setting, LSD can be used safely, but it produces significant sympathomimetic stimulation.

Meaning in life and perceived quality of life in Switzerland: results of a representative survey in the German, French and Italian regions.

BACKGROUND: The concept of meaning in life (MIL) has become a central one in recent years, particularly in psycho-oncology and palliative care. The Schedule for Meaning in Life Evaluation (SMILE) has been developed to allow individuals to choose the life areas that they consider to be important for their own MIL. This approach relates to the "World Health Organisation" definition of quality of life (QOL) as an individual's perception of his own position. The aims of this study were (i) to assess MIL in a representative sample of the Swiss population according to the three linguistic regions and (ii) to evaluate whether MIL constitutes a significant determinant of the perceived QOL. METHODS: A telephone survey of the Swiss population, performed by a professional survey company, was conducted between November and December 2013. The interview included the SMILE, perceived QOL (0-10) and health status (1-5), and various sociodemographic variables. In the SMILE, an index of weighting (IOW, 20-100), an index of satisfaction (IOS, 0-100), and a total SMILE index (IOWS, 0-100) are calculated from the areas mentioned by the participants as providing MIL. RESULTS: Among the 6671 telephonic contacts realized, 1015 (15 %) participants completed the survey: 405 French, 400 German and 210 Italian participants. "Family" (80.2 %), "occupation/work" (51 %), and "social relations" (43.3 %) were the most cited MIL-relevant categories. Italian participants listed "health" more frequently than German and French participants (50.4 % vs 31.5 % and 24.8 % respectively, χ(2) = 12.229, p = .002). Age, gender, education, employment, and marital status significantly influenced either the MIL scores or the MIL-relevant categories. Linear regression analyses indicate that 24.3 % of the QOL variance (p = .000) is explained by health status (B = .609, IC = .490-.728, p = .000), MIL (B = .034, IC = .028-.041, p = .000) and socioeconomic status (F = 11.01, p = .000). CONCLUSION: The major finding of our analysis highlights the positive and significant influence of MIL on the perceived QOL in a representative sample of a general, multilingual and multicultural population. This result indicates that the existential dimension is not only determinant for QOL in some critical life events, as shown e.g. in psycho-oncology and palliative care, but also in everyday life.

Brand Authenticity: An Integrative Framework and Measurement Scale

Although brand authenticity is gaining increasing interest in consumer behavior research and managerial practice, literature on its measurement and contribution to branding theory is still limited. This article develops an integrative framework of the concept of brand authenticity and reports the development and validation of a scale measuring consumers' perceived brand authenticity (PBA). A multi-phase scale development process resulted in a 15-item PBA scale measuring four dimensions: credibility, integrity, symbolism, and continuity. This scale is reliable across different brands and cultural contexts. We find that brand authenticity perceptions are influenced by indexical, existential, and iconic cues, whereby some of the latters' influence is moderated by consumers' level of marketing skepticism. Results also suggest that PBA increases emotional brand attachment and word-of-mouth, and that it drives brand choice likelihood through self-congruence for consumers high in self-authenticity.

Attitudes Regarding Palliative Sedation and Death Hastening Among Swiss Physicians: A Contextually Sensitive Approach.

In Switzerland, where assisted suicide but not euthanasia is permitted, the authors sought to understand how physicians integrate palliative sedation in their practice and how they reflect on existential suffering and death hastening. They interviewed 31 physicians from different care settings. Five major attitudes emerged. Among specialized palliative care physicians, convinced, cautious and doubtful attitudes were evident. Within unspecialized settings, palliative sedation was more likely to be considered as death hastening: clinicians either avoid it with an inexperienced attitude or practice it with an ambiguous attitude, raising the issue of unskilled and abusive uses of sedatives at the end of life.

Lorsque les électrosensibles racontent : des douleurs chroniques aux pratiques d'auto-éviction

Résumé : Cet article propose une analyse du vécu de personnes électrosensibles et de la façon dont ils ont répondu aux douleurs chroniques. L'approche proposée vise à relater les stratégies de réponse à ces formes de morbidité en valorisant les récits des protagonistes ; plus particulièrement, l'accent est mis sur les dimensions cognitives, sensorielles, émotionnelles, relationnelles et existentielles engendrées par une symptomatologie qui ne correspond à aucune explication scientifique causale. Leurs récits mettent ainsi en perspective des trajectoires de vie avec les conditions sociales, médicales et somatiques dans lesquelles est menée leur quête de santé. Mettre l'accent sur les expériences quotidiennes qui fondent la représentation que les électrosensibles ont de leurs troubles permet de comprendre les raisons et les modalités des formes d'auto-éviction qu'ils pratiquent. La réalisation des modalités de l'auto-éviction sont alors interprétées comme l'aboutissement d'une trajectoire de vie, produit de choix intuitifs - et non stratégiques - basés sur des sensibilités singulières. Il en résulte un regard anthropologique invitant à interpréter l'expérience des douleurs chroniques au prisme des rapports sensibles que les individus entretiennent avec leur corps, les autres et l'environnement. Abstract: This paper analyses the lived experience of electrosensitive people and the way they reply to chronic pain. The approach aims to relate the way they reply to this kind of morbidity by highlighting their narratives; especially by emphasising the cognitive, the sensorial, the emotional, the relational and the existential dimensions produced by a symptomatology that is not scientifically explained. Their narratives put into perspective their life trajectories with the social, medical and somatic conditions that lead their health quest. Focusing on the ordinary, that shapes the representations the electrosensitive people have of their troubles, would allow us to understand the reasons and modalities of auto-eviction practices. Auto-eviction achievement is interpreted as a life trajectory fulfilment produced by intuitive choices - nonstrategic - based on singular sensitivities. As a result, it invites an anthropological interpretation of chronic pain experiences built on the sensitive relationships that individuals have with their body, the others and the environment.