La psychopathologie développementale de la prise de risques, de l’addiction et de la transgression

Abstract

La psychoéducation occupe aujourd’hui une place essentielle dans le champ des approches psychosociales. En psychiatrie, elle est initialement proposée aux patients psychotiques chroniques ; elle s’est peu à peu étendue à d’autres types de pathologies du long terme, tels que les troubles bipolaires. Dès les années 1970, des cliniciens enrichissent les programmes de psychoéducation avec des composantes propres aux thérapies comportementales et cognitives (TCC). En 2009, la loi portant réforme de l’hôpital et relative aux patients, à la santé et aux territoires (loi HPST, 2009) a introduit l’ETP par son article 84 du droit français. Ainsi, nous proposons de discuter de cette nouvelle démarche, associée à la psychoéducation TCC, dans le cadre de la pathologie bipolaire. Nous décrirons le cadre théorique de la psychoéducation, puis des TCC appliquées au trouble bipolaire, nous aborderons le cadre de l’ETP et discuterons de sa complémentarité avec la démarche de psychoéducation TCC proposée aux patients bipolaires.Psychoeducation is an essential part of psychosocial approaches today. In psychiatry, it was initially offered to chronic psychotic patients, but has gradually spread to other types of long-term pathologies, such as bipolar disorders. Since the 1970s, clinicians have enriched psychoeducation programs with components specific to cognitive behavioral therapy (CBT) (Mirabel-Sarron and Giachetti, 2012). In 2009, the HPST law reforming hospitals and relating to patients, health and the regions introduced therapeutic patient education (TPE) in article 84 of French law. According to WHO (1998), TPE aims to educate the patient to acquire sufficient skills to be able to balance their life and optimal control of their illness. This is a continuous process, which is an integral part of medical treatment. It includes awareness, information, learning and psychosocial support, linked to the illness and treatment. This training should also allow the patient to better collaborate with their caregivers. This approach presents a certain number of overlaps with psychoeducation, cognitive behavioral therapy, and also certain nuances (Pancrazi et al., 2013). TPE is a practice by healthcare professionals, which consists of supporting a patient in singular significant, voluntary and authentic study so that they can manage self-care skills and adaptation to the illness and its treatment, in collaboration with their caregivers. The patient's education, especially in the context of chronic illness, focuses on the process by which the patient can make autonomous choices and is responsible for their own health in the illness and treatment. TPE programs and activities are created with reference to models and conceptions taken from information and communication techniques, but in particular from health and education. According to models taken by scientists, the objectives of therapeutic education differ and specifically target either patient instruction and compliance, or observation, self-knowledge, assistance in making choices, transfer of skills and/or patient autonomy. Today, the majority of CBT approaches for bipolar disorders associate psychoeducation with cognitive behavioral therapy techniques. Several studies (Docteur et al., 2013; Gonzalez-Isasi et al., 2010; Lam et al., 2003) have shown that this combined approach reduces the rate of depressive and manic relapses, the rate of hospitalisation, length of episodes and residual symptomatology, notably depressive, and considerably improves the quality of life of bipolar patients. Several authors have also shown that this approach could be offered to patients with multiple associated suffering with a significant improvement in symptomatology and psychosocial functioning. Therapeutic education is a humanist approach centred on the patient, their needs and their resources. It is also offered not only to help the patient to understand their illness and treatment but also to help them become more independent. It aims to value the patient's knowledge and skills as well as encouraging them to develop them and learn new ones. The integration of complementary TPE tools into the CBT psychoeducation approach could allow patients to acquire better awareness of their illness, gain greater knowledge about the different treatments prescribed, play a more important role in their treatment and so improve their quality of life.