Recherche clinique et innovation thérapeutique en psychiatrie militaire

Abstract

Introduction: The supposed objectivity of science can be contradictory to a clinical approach focused on subjectivity. However, research in the service of clinical practice constitutes a frontier zone between these two fields, and it is still necessary to define the limits of our actions and their orientation. How, beginning with the impediments of the clinic and respecting them, can we question whose interpretation could impact our way of providing treatment? While military psychiatry is a unique practice, clinical research in this environment also has its specificities.The specificities of clinical research: In addition to the psychiatric pathologies encountered in the general population, operational constraints are part of the military profession: the pace, nature, and duration of missions, the hostility of the environment, and the confrontation with potentially traumatic situations, are likely to produce so-called “reactive” psychic disorders. The richness of the military psychiatry clinic in this context is due to the fact that these constraints will put the individual psychological defense mechanisms under stress. Thus, casuistry assumes, from our point of view, a primordial place. This is why research in psychopathology has a special place in our practice.Between heritage and innovations: In addition to this approach, scientific research, whose effects are necessarily normative, proves to be valuable, particularly with regard to the optimization of drug therapies. Through the example of a clinical research project, dedicated to the individualized prescription of antidepressants via pharmacogenetics, we propose to illustrate the benefits of civil-military exchanges in this field. The interest in the military population is all-important: improving the effectiveness of treatments while reducing their side effects could bring about an optimization of care and a reduction in the duration of operational incapacity in personnel with specific jobs. It is also a question of integrating this research into daily practice, i.e. to ensure that its effects are used to benefit the patient. ConclusionClinical research is at once a necessary step as well as a challenge for military practitioners, allowing both the emergence of innovations and the integration of the most recent scientific contributions, while maintaining an ethical orientation guided by the realities of clinical practice.