Insertion dans les soins après une première hospitalisation dans un secteur pour psychose [Linkage to care after first hospitalisation for psychosis]

BACKGROUND: First hospitalisation for a psychotic episode causes intense distress to patients and families, but offers an opportunity to make a diagnosis and start treatment. However, linkage to outpatient psychiatric care remains a notoriously difficult step for young psychotic patients, who frequently interrupt treatment after hospitalisation. Persistence of symptoms, and untreated psychosis may therefore remain a problem despite hospitalisation and proper diagnosis. With persisting psychotic symptoms, numerous complications may arise: breakdown in relationships, loss of family and social support, loss of employment or study interruption, denial of disease, depression, suicide, substance abuse and violence. Understanding mechanisms that might promote linkage to outpatient psychiatric care is therefore a critical issue, especially in early intervention in psychotic disorders. OBJECTIVE: To study which factors hinder or promote linkage of young psychotic patients to outpatient psychiatric care after a first hospitalisation, in the absence of a vertically integrated program for early psychosis. Method. File audit study of all patients aged 18 to 30 who were admitted for the first time to the psychiatric University Hospital of Lausanne in the year 2000. For statistical analysis, chi2 tests were used for categorical variables and t-test for dimensional variables; p<0.05 was considered as statistically significant. RESULTS: 230 patients aged 18 to 30 were admitted to the Lausanne University psychiatric hospital for the first time during the year 2000, 52 of them with a diagnosis of psychosis (23%). Patients with psychosis were mostly male (83%) when compared with non-psychosis patients (49%). Furthermore, they had (1) 10 days longer mean duration of stay (24 vs 14 days), (2) a higher rate of compulsory admissions (53% vs 22%) and (3) were more often hospitalised by a psychiatrist rather than by a general practitioner (83% vs 53%). Other socio-demographic and clinical features at admission were similar in the two groups. Among the 52 psychotic patients, 10 did not stay in the catchment area for subsequent treatment. Among the 42 psychotic patients who remained in the catchment area after discharge, 20 (48%) did not attend the scheduled or rescheduled outpatient appointment. None of the socio demographic characteristics were associated with attendance to outpatient appointments. On the other hand, voluntary admission and suicidal ideation before admission were significantly related to attending the initial appointment. Moreover, some elements of treatment seemed to be associated with higher likelihood to attend outpatient treatment: (1) provision of information to the patient regarding diagnosis, (2) discussion about the treatment plan between in- and outpatient staff, (3) involvement of outpatient team during hospitalisation, and (4) elaboration of concrete strategies to face basic needs, organise daily activities or education and reach for help in case of need. CONCLUSION: As in other studies, half of the patients admitted for a first psychotic episode failed to link to outpatient psychiatric care. Our study suggests that treatment rather than patient's characteristics play a critical role in this phenomenon. Development of a partnership and involvement of patients in the decision process, provision of good information regarding the illness, clear definition of the treatment plan, development of concrete strategies to cope with the illness and its potential complications, and involvement of the outpatient treating team already during hospitalisation, all came out as critical strategies to facilitate adherence to outpatient care. While the current rate of disengagement after admission is highly concerning, our finding are encouraging since they constitute strategies that can easily be implemented. An open approach to psychosis, the development of partnership with patients and a better coordination between inpatient and outpatient teams should therefore be among the targets of early intervention programs. These observations might help setting up priorities when conceptualising new programs and facilitate the implementation of services that facilitate engagement of patients in treatment during the critical initial phase of psychotic disorders.

Attribution d'intentions hostiles et intentions comportementales agressives dans un contexte intergroupes

We conducted two experiments to demonstrate the relevance of group membership (in-group vs. out-group) in the processing of conflictual social interactions as described by Dodge (1980; Dodge, Pettit, Mcclaskey, & Brown, 1986). In the first study, we highlighted the impact of group membership on the attribution of hostile intents and on reactions to a provocation. In the second study we found that the impact of group membership on aggressive reaction intents is moderated by the status of people in the interaction, and that this effect is partially mediated by attribution of hostile intents. We conclude by stressing the necessity to integrate intergroup dynamics in the social information processing model elaborated by Dodge.

Exercices [de M.] Vasseur [Louis, champion du monde de force lors de son exhibition dans un gala de bienfaisance au palais du Trocadéro] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58394

Exercices [de M.] Vasseur [Louis, champion du monde de force lors de son exhibition dans un gala de bienfaisance au palais du Trocadéro] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58395

Exercices [de M.] Vasseur [Louis, champion du monde de force lors de son exhibition dans un gala de bienfaisance au palais du Trocadéro : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58396

AIRS A QUATRE // DE DIFFERENTS AUTEURS // RECVEILLIS ET MIS ENSEMBLE // PAR PIERRE BALLARD // Imprimeur du Roy. // A PARIS // Chez la veuve de R. Ballard et Pierre Ballard // Imprimeur de la musique du Roy. // Avec privilège. // Ce titre dans un cadre orné // 1606 //

Comprend : Fol 3 v° - Je fuyois l'amour et sa flame - Fol 4 v° - Ma foy, vous estes trop parfaite - Fol 5 v° - Alés facheux plain de loysir - Fol 6 v° - Ie suy exclave arresté - Fol 7 v° - Ayant ayme fidellement - Fol 8 v° - C'est pour l'amour de ma belle - Fol 9 v° - Il me faut trouver estrange - Fol 10 v° - N'est ce pas icy cette main - Fol 11 v° - Ce que j'avais prédit n'est que trop veritable - Fol 12 v° - Voulo, vous sçavoir mon malheur - Fol 13 v° - Amante plus inlortunée - Fol 14 v° - Un jour que ma cruelle - Fol 15 v° - Amour, vous avez l'oeil bandé - Fol 16 v° - Margot, il est Temps de conclure - Fol 17 v° - On a beau me cacher ton jour - Fol 18 v° - Ma bergere infidèlle - Fol 19 v° - Vous en allés vous mon soucy - Fol 20 v° - Quelle glace craintive - Fol 21 v° - Le mal qu'on ase das couvrir - Fol 22 v° - Que j'aime cas petits rivages - Fol 23 v° - Qui n'eut este vaincu d'un si fort ennemy - Fol 24 v° - Amans qui nuit et jour - Fol 25 v° - Que douce est la violence - Fol 26 v° - Que tous las feux du ciel ensemble - Fol 27 v° - Puisque l'amour peut bien exercer la puissance - Fol. 28 v° - Nous cherchons parmy ces prées - Fol. 29 v° - Berçevoy ne croyés pas - Fol. 50 v° - Ha beaux yeux je me rends non non, pluy jene joy - Fol. 51 v° - Père Bacchus, fils de femelle - Fol. 32 v° - Combien que ta fière beauté - Fol. 33 v° - Ma femme m'a dit un matin - Fol. 34 v° - Voy yeux qui font tant d'effets - Fol. 55 v° - Philis en songeant au tres pas - Fol. 56 v° - Beau pro qui charmoy mon Ame - Fol. 37 v° - Tu me dis adieu sans subjet - Fol. 38 v° - Quoy vous faites de la succrée - Fol. 39 v° - Ma foy, je vous trouve bien fin - Fol. 40 v° - L'infidelle qui commence