Étude de l’efficacité et de la tolérance des orthèses de repositionnement mandibulaire chez les patients atteints de SAS

Abstract

L’Accueil Familial Thérapeutique représente une modalité d’hospitalisation pour les personnes adultes atteintes de troubles mentaux, plutôt méconnue en France. Elle associe prise en charge dans une famille d’accueil et prise en charge institutionnelle. Pour les patients atteints de schizophrénie, l’établissement dispose d’un programme d’Éducation Thérapeutique autorisé. Nous nous sommes interrogés sur la pertinence de développer un module d’Éducation Thérapeutique spécifique aux familles d’accueil. Ces dernières présentent-elles des difficultés dans leur pratique quotidienne ? L’Éducation Thérapeutique peut-elle leur apporter une aide et peut-elle être intégrée au programme ? Après avoir mené des entretiens semi-directifs et l’analyse thématique de contenu des verbatims de deux clusters de six familles d’accueil, nous avons mis en évidence 15 thèmes et 46 sous-thèmes pour leurs « difficultés à exercer leur métier ». Souvent seule, confrontée au patient psychotique, sans formation reconnue, la famille d’accueil thérapeutique verbalise un besoin de connaissances et de compétences. L’Éducation Thérapeutique, intégrée au programme d’Éducation Thérapeutique du Patient existant, peut les aider à développer leurs compétences psychosociales, les informer sur la pathologie, les addictions, les particularités des patients plus jeunes dans la maladie et leur apporter des clés pour « faire face » au quotidien.Therapeutic Foster Homes represent a form of hospitalization in France for adults with mental disorders. It combines, “care” in a foster family (carer) and treatment by a mental health team. The institution has a Patient Therapeutic Education program for patients with schizophrenia. We questioned the relevance of developing a therapeutic education module specific to carers. Do they face difficulties in their daily practice? Can Therapeutic Education help them and can it be integrated into the program? We chose to explore this issue using a qualitative method with semi-directive interviews. They were conducted in the “life stor” mode by guiding the interview around the description of their daily activity and highlighting the problem/situations encountered. After transcribing the recordings, a thematic analysis of each interview content was carried out by two different professionals. Thematization was driven in a sequenced manner. A first list of themes was obtained from the first interview, then this list was reused for subsequent interviews and adjusted as the interviews progressed. The themes and sub-themes were also weighted by their presence in the interviews in order to prioritize them. After analysis of the verbatims of two clusters of six families, we highlighted 15 themes and 46 sub-themes for their “difficulties in carrying out their profession”. These cover 45 different tasks, grouped into ten types of tasks. These difficulties are mainly related to “relations with the professionals of the system” for 24%, “patient profile” for 18%, “daily management” for 11%, “risks incurred by the foster family”; and “incomplete training”; for 8%, “permanent involvement of private and professional life”; for 6%. Despite the training provided by the establishment since 1993, carers still feel helpless on a daily basis. The study also attempted to link the difficulties to the tasks of the work: 28% of therapeutic foster carer encounter difficulties in adapting to different situations, 17% in “teamwork”, 16% in “organization of privacy and professional life”, 12% in “giving a framework to the patient”, 11% in the acquisition of knowledge and skills. Therapeutic education could complement the training provided by addressing needs in more targeted fields and thus better adapt to the field needs of family foster. In line with the Patient's Therapeutic Education programs, three lines of intervention could be offered: an educational axis, a psychological axis and a behavioral axis. Educational activities could include providing knowledge about their profession, psychiatric pathology and its treatments, preparing for the difficulties of the profession (stress management, repetition and failure management, professional and personal time management, risk of overemotional involvement…) and providing tools to adopt the right attitudes according to the situations (communication techniques, problem solving techniques). We can draw on the programs developed for natural families and adapt them to their problems. It would also be interesting to exploit the tools already used for patients in the Therapeutic Education program for the benefit of carers; this could be done in the Drugs and Schizophrenia workshop and/or in some cognitive remediation programs (ex: Integrated Psychologic Treatment). The presence of “old”; and “new” Family Hoster Carer in the field would be relevant, in a dynamic of sharing experiences. This approach could be accompanied by an immersion of a few days in host families. Alone, confronted with the psychotic patient, without any recognized training, the carer verbalizes a need to provide knowledge and skills. Therapeutic Education, integrated into the existing Patient's Therapeutic Education program, can help them develop their psychosocial skills, inform them about psychiatric pathology, addictions, the particularities of the new patients and provide them with keys to cope on a daily basis. This work is consistent with the institution's psychosocial rehabilitation vocation.