Cyril hazif-thomas

• Centre Hospitalier Universitaire de Brest, French Institute of Health and Medical Research

Communication Fin de vie et souffrance psychique intolérable. Contiguïté éthique ou option législative : quel paradigme retenir ? The end of life and unbearable mental suffering. Ethical and medical contiguity or legislative option: What paradigm to choose?

La mémoire n'est pas un stock d'éléments abstraits immuables, mais plutôt un réseau sémantique et symbolique en constante évolution. Les traces mnésiques sont partiellement constituées d'informations motrices et sensorielles. Elles s'ajoutent aux événements, aux émotions vécues dans le contexte de l'apprentissage. Elles sont modifiées à chaque rapp...

Medical prescription in psychiatry for the elderly is often a complex process for doctors. It involves more than writing a script for medications. It also concerns all of the medical actions for the person who is ill or for the implementation of assistance and support to their family or professional carers. In psychogeriatrics, issuing prescription...

Background. Alzheimer's Disease (AD) is a neurodegenerative illness, which occurs with increasing frequency as people age, and is currently a disease beyond curative therapeutic possibilities. While progressive memory impairment is the upfront element associated with the disease, other neurocognitive problems are also associated with it, such as la...

Taking into account the needs and expectations of families in residential care facilities for the dependent elderly (Ehpad) leads to their satisfaction with the care given to their institutionalized relative. A relational charter participate to prevent conflicts and misunderstandings between the various formal (caregivers) and informal (families) c...

Résumé Le discours dans la relation de soins fait le pont entre la relation humaine et un parcours de soins, permettant aux malades de l’accepter et parfois d’en assumer la pénibilité. Ce discours permet des échanges techniques entre médecins, soignants et patient. Si les conditions d’écoute en profondeur et d’empathie réciproque sont présentes, le...

La finalité de la mémoire est de transmettre les leçons de l'expérience humaine, et d'éviter la reproduction d'évènements dangereux. La mémoire humaine et collective est à la base de souvenirs. Au cours du temps, leur sens s'éloigne des faits observés autrefois, tant pour des raisons affectives que groupales. Accéder au présent des souvenirs, c'est...

Le grand âge, l’isolement, les troubles cognitifs facilitent les abus de faiblesse et les violences sexuelles chez les personnes âgées vulnérables. Rapporter les faits ne leur est pas toujours aisé. La honte ressentie, mais aussi les troubles cognitifs peuvent être des entraves pour rapporter les agressions subies. Plus souvent que chez les adultes...

La sexualité chez la personne âgée reste un sujet encore tabou. Des stéréotypes négatifs sont souvent véhiculés par la société. Contrairement à l’opinion commune, le désir sexuel persiste aux âges avancés. L’activité sexuelle a un impact positif sur le bien-être psychologique, cependant la sexualité doit être adaptée au corps âgé car elle peut être...

Résumé En France, les Soins Psychiatriques Sans Consentement (SPSC) poursuivent depuis une dizaine d’années leur évolution à marche forcée, au rythme des injonctions du Conseil Constitutionnel à légiférer. Le psychiatre ne prescrit plus mais participe d’une décision de dernier recours prise à visée conservatoire dans le cadre d’une démarche thérape...

Severe forms of Covid-19 infectious disease often affect the frail elderly. They can induce inaugural psychiatric manifestations or aggravate the underlying psychiatric pathologies. Some of these pathologies persist after the acute episode and require specific management. Doctors and caregivers involved in the care of infected patients are themselv...

Working on the question of consent in psychiatry means studying closely the word given by a patient, who, before being mentally ill, is a person with a real human value. It is a question of eliciting consent, of seeking it tirelessly rather than demanding it, so that it never becomes a procedure imposed by the fact of setting a purely formal condit...

The subjective recognition by those involved in care, of people with psychiatric disorders, is not self-evident. Caregivers, in the general sense of the term, often find it difficult to recognise the personal freedom and dignity of psychiatric patients. Care is, however, inseparable from the relationship of trust and the mobilisation of the patient...

Background. Alzheimer’s Disease (AD) is a neurodegenerative illness, which occurs with increasing frequency as people age, and is currently a disease beyond curative therapeutic possibilities. While progressive memory impairment is the upfront element associated with the disease, other neurocognitive problems are also associated with it, such as la...

Compassion fatigue and empathetic suffering are terms generally applied to health care providers caring for elderly people. An exhaustion accompanied by acute emotional pain results of tension and preoccupation with the suffering of those being helped. Learning to recognize it and to manage its symptoms is the first step toward healing. Compassion...

La personne âgée souffrant d’une pathologie neurodégénérative n’est plus en capacité de gérer ses émotions ou d’exprimer ses choix comme auparavant. Le malade lutte contre la perte des habilités, non comprise par l’entourage. Le trouble du comportement, le plus souvent oppositionnel, témoigne de la douleur morale que les professionnels ont à décele...

Résumé La maladie d’Alzheimer, la schizophrénie, l’autisme… sont classiquement des maladies affectant principalement la personne dans leur être-avec et l’être-au-monde. Elles altèrent progressivement de nombreux processus cognitifs et affectifs, en premier lieu la mémoire, mais aussi le jugement et le langage. Leurs interactions conduisent à une pe...

Violence towards the elderly can occur in various forms. These include domestic or institutional abuse but other more covert forms exist. The complex conditions of their appearance, both in the elderly victim as well as in their abusers imply a pluridisciplinary repsonse. It is essential to preserve the notions of humanity, the safety of the elderl...

Violence towards elderly people can be hidden or trivialised. It often results from misunderstandings adding an argumentative edge to the relationship. Its prevention involves respecting elderly people's wishes and acknowledging their efforts and their anxieties and not simply pointing at the inadequacy of the resources available in a practice stil...

Cognitive disorders of Alzheimer's disease are not the only determinants of the behavioral disorders of the elderly. A transgressive will may be underlying, related to the life story or archaic psychological defense mechanisms. As a result, their human environment is distressed which sometimes aggravates behavioral problems. In institutions, this s...

Family carers play a key and indispensable role in today's society. What is their legal status and what have been the stages of their recognition? It would appear that their situation fluctuates between a status in the process of being constructed and the temptation of self-sacrifice. Copyright © 2018. Published by Elsevier Masson SAS.

Living at home as long as possible, adapting 'old age' policies to dependent elderly people, using new technologies to enable elderly people to remain at home and funding dependence are just some of the challenges facing today's society. The law relating to the adaptation of society to ageing was constructed around the notion of autonomy. This arti...

Background. Alzheimer’s Disease (AD) is a neurodegenerative illness, which occurs with increasing frequency as people age. While progressive memory impairment is the upfront element associated with the disease, other neurocognitive troubles are also associated with it, such as language impairment which can degenerate into aphasia. Language disorder...

The discourse of a demented patient refers to an existential reality. It seeks to shape a meaning of life still shareable, to share a vision of oneself through the presence of the other. The conditions for facilitating expression and empathetic listening are discussed below.

Les troubles cognitifs de la démence d'Alzheimer s'ins-tallent progressivement, et de façon hétérogène. Des mo-dalités de fonctionnement mnésiques persistent au moins aux phases débutantes et modérées de la maladie. Les troubles de la mémoire interfèrent avec la vie affec-tive et émotionnelle du malade. Nous parcourons dans cet article les probléma...

The pain of not being recognised in the fight against Alzheimer's disease is a question of non-sharing rarely considered by medicine, but which is nevertheless a significant issue for the patient and carer. This anxiety relating to the fracture of the being emerges when being faced with the ordeal of Alzheimer's disease becomes a source of unfathom...

Few caregivers know what analogons are, yet they use them on occasion, intuitively, for the benefit of their patients. An analogon, an identifying object, enables patients with cognitive disorders to 'decipher' their environment and find meaning in it. Caregivers sometimes use analogons without being aware of the theory behind them.

Conflicts between families and caregivers in a nursing home have multiple causes centred (but not exclusively) on the interest of the resident. Intrafamily conflicts can lead to tensions between families and caregivers. Alzheimer's disease changes the relations with the patient's family members when they are involved in the care, which can lead to...

Résumé Les troubles du comportement sont fréquents dans la maladie d’Alzheimer. Ils reflètent parfois une tension entre, d’un côté, ce que le malade savait faire, ce qu’il aimerait continuer et, de l’autre, l’horizon cadrant des objectifs soignants. Les difficultés praxiques en particulier instrumentales sont source d’échec dans ce qu’il entreprend...

Résumé La maladie d’Alzheimer est une maladie organique du cerveau à l’origine de désordres cognitifs. Des conflits intrapsychiques antérieurs, des deuils aggravent le cours de la maladie. Le rappel de certaines traces mnésiques peut ainsi renvoyer à des événements douloureux de l’histoire de vie confrontant la personne à des émotions intenses et p...

Dementia brings about progressive cognitive deterioration, combining memory problems, language difficulties and thought disorders. While there is currently no treatment for the organic disorders causing the dementia, help can be given to patients to slow down the regressive processes. Psychological mediations exist to support patients in their effo...

Résumé Construire une réflexion éthique, source d’interdépendance entre soignés et soignants, de dialogue à ne jamais rompre entre profanes et experts, est un préalable indispensable afin de respecter l’essence même de soin. Mais il y a une difficulté propre à ce moment du soin historiquement situé, qui oblige à laisser la « morale close » pour all...

L’objet identifiant est un objet qu’en langage profane on appellerait volontiers « baguette magique » ou « objet phare », soit un repère situationnel venant au secours d’une adaptation introuvable, à la valeur transactionnelle, motivationnelle et communicationnelle certaine. C’est un objet qui oblige le soignant à penser en dehors les cases et appe...

Le but de cet article est de présenter les résultats de la musicothérapie et d’analyser certains de ses effets sur des patients atteints de maladie d’Alzheimer ou des troubles cognitifs organiques apparentés. Les résultats de méta-analyses confirment les effets importants des ateliers thérapeutiques par la musique sur l’anxiété et la dépression des...

Alzheimer's disease is accompanied by gradual aphasia, becoming more severe when the cognitive disorders are more marked. However, the quality of care provided to the patient can modulate the evolution of these language difficulties. Aphasia is linked to a human communication deficiency and can be limited by taking into account the phatic function...

An elderly person's use of alcohol can conceal undernutrition, cognitive decline due to dementia or depression. Caregivers have an important role to play with these patients in distress. It is necessary to help them regain their self-esteem and to support their will to live to restore the relationship with others. Copyright © 2016. Published by Els...

Caring for a patient suffering from Alzheimer's disease is a real challenge which few doctors fully appreciate. The manners of an agitated patient can sometimes destroy emotional bonds and require collaboration both with the family helpers and all relevant health professionals. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Consideration of pain in mental health proves fundamental in psychiatry, a fortiori psychogeriatrics. The elderly person is often confronted with a painful existential situation and the experience of physical pain that go unheard. This algic component of somatic origin is still, like moral pain, too trivialized, because of becoming elderly too fast...

Alzheimer’s disease is accompanied by progressive aphasia which intensifies the cognitive problems. The quality of the care given to the patient influences, however, the evolution of his language difficulties. The way the vulnerable person is aided, and the extent to which his efforts to make himself understood by his human environment are validate...

Mémoire et sens forment un ensemble qui donne corps à la subjectivité. Ils composent le registre des stratégies personnelles en organisant les formes de vie, ils permettent d’asseoir la personnalité, validant ou infirmant les choix de la personne par l’école de l’expérience, et ils structurent le lexique des émotions à travers le jeu des rites et d...

Dementia questions and undermines the content exchanged and relational codes. What is the true nature of these disorders? While they are not psychotic disorders, they evoke a psychiatric revelation of Alzheimer's disease. It is therefore necessary to design a mental health policy which is equal for everyone and encourage ethical reflection around t...

Formal caregivers, elderly residents and families encounter numerous difficulties when an elderly relative is institutionalized in a nursing home. Numerous problems come to light there, linked to the development of different, sometime competitive, logics in two human groups that are unbalanced in terms of power, the family system and the geriatric...

Nous proposons, dans cet article, de faire le point sur les hallucinations négatives chez la personne âgée et sa prise en charge. Être capable de produire des hallucinations négatives est une compétence paradoxale amenant à halluciner à propos de rien. Il en va de la représentation de l’absence, à visée anti-traumatique. L’hallucination négative du...

Résumé Les troubles psychotiques sont donc parmi les symptômes non cognitifs les plus fréquents de maladie d’Alzheimer et sont associés à la plus grande altération cognitive. Le statut hétérogène de ces symptômes psychologiques et comportementaux dans la démence fait débat. Leur valence psychotique en particulier interroge quant à la véritable natu...

The question of the links between anorexia and the refusal to eat in the elderly is often the cause of major difficulties with regard to therapeutic strategies within caregiving teams. Likewise, few studies have been carried out into the diachronic links between teenage anorexia and that of the elderly. The role of the multi-disciplinary team is es...

The persistence of compulsory hospitalization in psychiatry is still a topical question within the atmosphere of violence and even of barbarism which comes to light in our society. Given opinions get more radical and demand zero risk in psychiatry, it becomes a lack of political ambition to carry on speaking of medical approach on the one side and...

Empathy is one of the qualities which enable caregivers to develop high quality care. The circumstances of professional practice such as pressure and lack of time can see this quality pushed to one side. The risk of burnout is all the greater as empathy alone does not protect caregivers from submitting themselves to their hierarchy. Compassion, on...

The issue of self-neglect in the elderly concerns society as well as caregivers who, in their practice, are ill at ease and frequently disorientated when faced with this behaviour which hampers the care approach. Here more than elsewhere, the choices of the people in question seem to collide with the care objectives, in such a way that it is import...

Ageing requires a time of adaptation necessary for a person's loved ones and the environment, as well as the ageing body. Changes are imposed which require a new psychological energy to counter the losses and sometimes the traumas. Communicating in order to create a certain amount of resilience is one of the challenges of geriatric psychiatry.

Résumé Les sociétés occidentales vieillissent, conséquence du baby-boom d’après-guerre. Le grand âge s’accompagnant parfois d’une perte d’autonomie, une épidémie de dépendance peut se profiler dans les futures décennies, grevant gravement à terme les finances publiques. C’est dans ce contexte qu’une des solutions envisagées était de prévoir la mise...

A delusion is any misconception which goes against all evidence to the contrary, whether it be an inaugural delusion or whether it occurs with the development of dementia. Chronic delusions are distinct from acute delusional expressions, of greater or lesser conviction, which are seen as symptomatic productions in dementia patients and are sometime...

L’entrée en Établissement d’hébergement pour personnes âgées dépendantes (EHPAD) ne signifie pas en tant que telle pour la famille la fin de son engagement dans le soin. Les conflits entre les familles et les soignants ont de multiples causes centrées, mais non toujours, sur l’intérêt bien compris du résident. De façon générale, les familles, clien...

Negative hallucinations are characterized by a defect in perception of an object or a person, or a denial of the existence of their perception. Negative hallucinations create blank spaces, due to both an impossible representation and an incapability of investment in reality. They have a close relationship with Cotard's syndrome, delusional theme of...

Freedom to come and go is a very old human right in France. Compliance in psychogeriatric units is not easier to enforce in a nursing home hosting vulnerable patients, especially in secured accommodation units. Indeed many EHPAD or USLD actually possesses UHR or closed units. They have for peculiarity to have a door closed, limiting the possibility...

La reconnaissance des personnes ne va pas de soi dans le champ psychiatrique, caractérisé par le constat fréquent d’une liberté aliénée. Elle ne va pas de soi en particulier avec les personnes souffrant de troubles psychiatriques, et dont nous avons du mal à reconnaître leur liberté personnelle et sanitaire dans leurs actes parfois étranges, incomp...

Demotivation results from a pathological process that is not a part of normal ageing. It differs from a mood disorder, but it can often be associated with one. Linked to physical autonomy and/or mental losses, it can be a gateway to regression, increasing or establishing dependency.

Raising the question of the end of life in contrast to the hunger of life could seem challenging in the current debate, opening the possibility of supervising the euthanasia request. Yet, it is legitimate to reconsider the philosophical and legal questions that this issue underlines. It is also important to accept to look at the ethical and human i...

Bound to the idea of a crisis and the brutal intrusion of psychological suffering, the suicide drama rarely lends itself to a direct analysis which can highlight the different stages of its process. Taking into account increasing quantities of scientific data from current research and the spirit of crisis interventions is fundamental for allowing h...

Mental health must be distinguished from the medical discipline of psychiatry, especially with regard to elderly patients, for whom, all too often, the care approach consists in admission to an institution. All sectors of psychiatry must be concerned by the mental health of the elderly.

Mental health and solitude in old age. Elderly people experience solitude as isolation, even more so when the person is ill. However, in the same circumstances, some people see solitude as an experience of maturity. Is it simply a question of inner strength?