Psychiatric Semiology Research Articles

Charcot’s contribution to the problem of language in mental medicine

ABSTRACT Jean-Martin Charcot’s 1883 lectures on aphasia at the Salpêtrière Hospital were seen as the starting point for the development of a psychology in the work of the famous neurologist. In his lectures, Charcot set out a theory of language function at the cerebral level, distinguishing between the different centers involved in speech production and those necessary for reading. His lectures, which also postulated the independence of ideas from words, were to resonate beyond aphasia specialists, and particularly with alienists. To document this dimension of the reception of neurology in the field of psychiatry, this article refers to Jules Séglas’s synthesis on Les troubles du langage chez les aliénés, published in 1892, which summarized the knowledge acquired during the nineteenth century about modifications of expression in madness and whose original ideas were to mark the psychiatric semiology of the early-twentieth century. The analysis details how Séglas cited and adapted Charcot’s conceptions to explain the production of incomprehensible speech in idiocy and the formation of hallucinations, thus contributing to the spread of the neurologist’s model among his fellow alienists.

Disjonction entre image et identité : histoire et actualité du signe du miroir

ObjectiveThis article focuses on the “mirror sign” as an element of psychiatric semiology. Considered as a prodrome of schizophrenia during its description between 1927 and 1930, the article aims to shed light on its contemporary relevance, particularly with regard to changes in society concerning the subject's relationship to their image as well as the relationship to identity or self. MethodAfter reviewing the history of the discovery and description of this sign, in order to shed light on its origins and on some essential elements, we take up the hypothesis of a link between a failure of the Lacanian “mirror stage” (stade du miroir) and the occurrence of the sign of the mirror. Links between original description, the frequency of body image disorders in psychosis, and the consequence of the mirror stage on symbolic identity are clarified. A few clinical fragments allow us to question the unfolding hypothesis. ResultsThe mirror sign appeared at the beginning of the 20th century as a prognosis for schizophrenia. Alienists linked it to homosexuality, then considered pathological. It appears today that the clinical class of the disorders that can be referred to this sign emerges essentially from a disjunction between body image and identity. This sign can be heuristically put into perspective with the Lacanian statement unpacked in “Le stade du miroir comme formateur de la fonction du Je,” and with the hypothesis that the psychotic structure also offers subjects the possibility of non-standard symptomatic responses. The sign of the mirror and the subjective responses that result from it shed light on what it is that some subjects seeking to create, by working on their image, on their body, a new identity, to respond to an initial perceived disjunction between image and identity. DiscussionIf the sign of the mirror inspires a large number of subjective responses aimed at modifying the body to make it conform to a new identity, and thereby carrying viable neo-identity solutions, it is not experienced without some discomfort in most cases. Nothing makes it possible to predict its future, and the therapeutic action is limited to identifying this sign and supporting the possible elaborations of the subjects who aspire to produce a conjunction between image and identity. ConclusionOne hundred years after its discovery, the mirror sign, is still an extremely relevant element of psychiatric semiology. It does not necessarily constitute a prodrome of schizophrenia, but it indicates a subjective difficulty in associating image with identity. The symptomatic response of the subject does not require the validation of the clinician; it is linked to a subjective malaise, which can be welcomed, whatever the outcome of this sign.

Psychiatric semiology in postmodernity

This article intends to reflect on the validation of psychiatric semiology and nosography that is taught in clinical psychologists and psychiatrists training programs. The vision of academic psychiatry of our times, strongly influenced by scientific narrative, seeks to consolidate an universal nosography that aims to erase the culture marks. However, the prevalence of certain diagnoses over others is determined by the social context and cultural changes that determine, in turn, the classifying standards of professionals. For this reason, it is important to include the contributions of public intellectuals and cultural theorists for an updated and culturalized semiology of clinical phenomena. We will use the developments of Mark Fisher on Capitalist Realism to rethink the main symptoms of depression.

L’expert judiciaire et l’irresponsabilité pénale. Débats et controverses au cours du temps et questions contemporaines

L’expert judiciaire et l’irresponsabilité pénale. Débats et controverses au cours du temps et questions contemporaines

Psychogenic epidemic - mass hysteria phenomena in Portugal

IntroductionMass hysteria also called mass psychogenic illness (MPI), defined as a social phenomenon, consists of collective anxiety due to a perceived threat and can culminate in a cascade of symptoms suggestive of organic disease without an identifiable cause. Its history dates back to the 14th century and impacts people from all cultures and regions of the world. Before the 20thcentury, MPI emerged across Europe, often in socially isolated convents, in highly stressful environments.Objectives The aim of this study is to explore the available literature on mass hysteria phenomena in Portugal, historical origins, applications and eventual position in modern psychiatric semiology.MethodsNon-systematic review of literature published in Medline/Pubmed. Search terms included: mass hysteria, nocebo, groupthink, emotional contagion.Results In Portugal two great phenomena of mass hysteria were described. In 1917, the “sun miracle” occurred, where thousands of individuals reported having seen the sun rotating in the sky and changing its size and colours. Years later, more than 300 students from 14 schools described the same symptoms: dizziness, dyspnea and rash, without an identifiable cause. In common these young people had “sugar strawberries”. In May 2006, the young people in the television series were infected with a vírus, and clinical picture was similar to that presented by young people in real life. For the first time, a fictional illness on television triggered an illness in real life.ConclusionsMore studies should be carried out on these phenomena as their early recognition can have a tremendous impact on the ease of identification, diagnosis and treatment.DisclosureNo significant relationships.

Postgraduate Psychiatry Training Programme in Morocco

AimsThe field of psychiatry in Morocco has grown significantly since the 1970s, from less than 10 psychiatrists to the current number of around 400. The increased number of practising psychiatrists has enabled the expansion of local residency training programmes, which has been set up since 1974 to cater for the population needs of more than 36 million population of Morocco. This study is aimed to describe the current medical educational approach of the Moroccan postgraduate psychiatry training programme.MethodsThis descriptive medical educational study was based on official training documents and interviews with local faculty members involved in the training.ResultsThe entry requirement of the four-year Moroccan postgraduate psychiatry residency programme includes the completion of 1 year of foundation training and passing the entrance examination consisting of psychiatric semiology and pharmacology. The postgraduate residency programme is run by the local universities in collaboration with the Ministry of Health and accredited by the Moroccan government. Trainees have the option of taking up a voluntary or contractual position with the government or University Hospitals. All trainees will go through 34 months of general adult outpatient and inpatient, while liaison psychiatry training starts from the second year until the end of the training. On top of the core rotation, a trainee can opt for two months in old age and neuropsychiatry postings. Child and adolescent rotation is currently not available. Addiction psychiatry training is optional and can be done through a university diploma. The 4th year is a 12-month elective posting in any discipline that is relevant to psychiatry, which can be done either locally or abroad. Teaching methodologies involve lectures, seminars, ward rounds, case conferences, journal clubs, and skill training workshops. Formative assessments included case-based discussions and mini-clinical evaluation exercise. There are multiple high stakes summative assessments at year 1, year 2, year 3, and year 4. The summative assessment strategies includes modified essay question, clinical short case and long case. Viva voce is used to assess competency in research. Different mandatory skill competencies include electroconvulsive therapy, psychotherapy, and research.ConclusionThe advancement of local postgraduate psychiatry residency training in Morocco has improved the access of local trainees to quality training. Similar to other developing countries, Morocco requires more psychiatrists to improve the psychiatrists to population ratio so that the mental service can become more accessible to the local population.

L’importance du discours intérieur dans la sémiologie psychiatrique

ObjectivesEntangled in a semiology that aspires to imitate medical semiology, psychiatry does not take seriously enough the question of internal discourse, while many psychiatric phenomena relate to the articulation between internal discourse and external discourse.The intention of this article is to draw the attention of psychiatry to the issue of internal discourse, which is insufficiently addressed within the discipline. Psychiatric semiology should be more interested in and should approach this issue of internal discourse differently. For this, it could integrate the contribution of modern linguistics and rediscover Jacques Lacan's theory of language. MethodThe article first recalls the basic principles of psychiatric semiology based on the work of Lanteri-Laura, Henri Ey, and, more recently, that of Steeves Demazeux. He shows how psychiatry has moved from a classical semiology based on the body to that of mental faculties, more or less attached to bodies. The question of internal discourse does not find its place in these approaches. DiscussionHallucinations, delusions, obsessive and melancholy ruminations… All these phenomena are related to the question of inner speech. This does not mean that they are similar or should be approached in a comparable way. ConclusionHuman beings seem to be both speaking through their outwardly directed speech and partly spoken, through their internal speech. This must be taken into account not only from a semiological point of view but also when it comes to organizing care.

Les Aventures de Tintin, l’œuvre d’Hergé au regard de la psychiatrie

Hergé’s “Adventures of Tintin” is a renowned Belgian comic book series. The twenty-four albums are rich in psychological and psychiatric elements, intricately woven into a smartly written and complex storyline. These elements have, however, seldom been studied systematically from a psychiatric point of view. In the current paper, we propose a systematic review of the series and of the medical literature concerning the psychiatric semiology and phenomenology found in the work of Hergé. The search terms used in the Pubmed database were “Tintin”, “medicine”, “medical”, “health”, “mental”, and “psychiatry”. Upon reading the integrality of the twenty-four albums, the most recurrent themes found were delusions and psychosis, personality disorders, and alcohol and other psychoactive substance use disorders. We then conduct a chronological analysis of the evolution of the representations of asylums and psychiatric hospitals, psychiatrists and the “mad man” throughout the albums. Finally, we present the psychoanalysis of the “Adventures of Tintin”, as developed by the psychiatrist and psychoanalyst Serge Tisseron, who, upon reading Hergé’s work, suspected the existence of a family secret that the author might have concealed in his albums.

Discours et psychotropes

ObjectiveCaregivers in the mental health field deal mainly with patients’ thoughts; their primary access to these thoughts is listening to what the patient says. It is important to distinguish the dimension of utterance from that of enunciation. This also applies to the prescription of psychotropic drugs. This article aims to return the issue of discourse to the center of mental health concerns and to draw the attention of psychiatrists and other caregivers to the concept of enunciation, in the case of psychotherapy but also for the prescription of psychotropic drugs. MethodThe article takes a detour through linguistics by retracing the field's evolution: from associationism and the brain regions associated with ideas to structural linguistics and, more recently, to the emergence of the distinction between utterance and enunciation. This distinction shakes up the discipline by introducing the questions of subject and truth. The article then addresses the influence of linguistics in psychiatry and recalls that the question of enunciation was already present in the works of Jacques Schotte and Jacques Lacan. ResultsThe psychiatric tradition has not sufficiently taken the question of enunciation into account. Psychiatric semiology has mainly been limited to patients’ utterances and behaviors. Schotte, and especially Lacan, attempted to formalize enunciation and dealt with consubstantial questions: the subject and the truth. DiscussionHow could psychiatry integrate the question of enunciation into its semiology? Does a typology of discourse allow us to establish a semiology of enunciation? Does care (therapy, psychotropic drugs, etc.) focus more on utterance or enunciation? ConclusionPsychotropic drugs are not, in themselves, treatment for mental illness. Their effect is on the person's enunciation and possibly on his or her utterances. The duration and dose of psychotropic drugs is to be modulated by listening carefully to patients’ discourse. Psychotropic drugs can act on the possibilities of speech; they must free speech in such a way that a thought (delirious, obsessive, melancholic, or other) ceases to be embarrassing or invasive.

Prospective study on a fast-track training in psychiatry for medical students: the psychiatric hat game

BackgroundWhile medical students are losing interest in lectures in favor of other educational materials, many studies suggest the benefit of active learning, combined with gamified educational tools. The authors developed a psychiatric adaptation of the « Hat Game ». It was hypothesised that this game would increase both knowledge and motivation in medical students toward psychiatric semiology. The aim of the study was to assess the benefit of a Psychiatric Hat Game session for learning psychiatric symptoms in third-year medical students. Student performance was also evaluated at 3 months.MethodsThis gamified fast-track training consists of two teams and each team has to guess as many psychiatric semiology terms as possible using different techniques (i.e. speech, mime). The study involved a pre- and post-evaluation of knowledge (Multiple Choice Questions) and a satisfaction survey. Baseline, post-immediate, and three-months scores were compared by using Friedman analysis for paired samples. Comparisons of mean scores at two different times were performed by using Wilcoxon test for paired samples.ResultsOne hundred and sixty-six students were proposed to take part in the study. Among them 129 completed the whole program (response rate = 77.7%). Mean scores measured at the three points in time were significantly different (p < 0.001, N = 129). Knowledge mean scores were significantly higher after the game than before (+ 28.6%, p < 0.001). Improvement was maintained 3 months after the game (+ 18.9%, p < 0.001). Satisfaction survey items highlighted that students enjoyed and would recommend this type of gamified training.ConclusionsThe Psychiatric Hat Game improved knowledge of psychiatric semiology in medical students. Results suggest that it is a promising and efficient tool to playfully teach medical semiology, with transferable features, utility and acceptability from one medical field to another. This study contributes to the growing body of knowledge advocating for serious games and gamified training in medical education.

Schizophrénie et rétablissement : analyse phénoménologique d’un cas de retrait positif

ObjectivesThe recovery paradigm has emerged in mental health over the last thirty years, referring to the subjective and dynamic process by which a person achieves a satisfying life, relying on his/her strengths, his/her values, and the very experience of his/her psychiatric illness. The understanding of the experience of people living with schizophrenia and engaged in a path of recovery is undermined by an objective and categorical psychiatric approach, targeting symptoms and deficits to be compensated. We propose a phenomenological approach to a clinical situation of positive withdrawal, as developed by Corin and Lauzon, as a form of recovery for the schizophrenic subject, in order to shed light on the first-person experience of what psychiatric semiology refers to as negative symptoms, apragmatism and social withdrawal. MethodWe develop the single case of Sam, 39 years old man who has been treated for schizophrenia for about 10 years. He talks about his “spiritual schizophrenia”, which has in the past generated a demon above his head guiding his aggressive behaviors. Since he was discharged from hospital three years ago, Sam has become an “ordinary person” again, according to him. His daily routine is ritualized by a weekly activity at the day hospital, daily nursing visits at home, television, and visits from two friends on weekends. He explains that he needs peace and quiet around him and like to be aware of his neighbourhood and village lives and events. He listens to his spiritual guides and his gift of clairvoyance, which predicted him, more happiness from his forties onwards by getting a job and by a love encounter. We propose a phenomenological analysis of his experience of recovery and positive withdrawal. ResultsSam's embodied experience was previously characterized by a confusion between the intentional and sensitive flesh (Leib) and the objectified body (Körper), disembodied and materialized as if on the outside by a demon on top of his head. Today, it seems to be re-articulated in a dialectic harmony between Leib and Körper. Sam inhabits his body in an embodied life, as an interface between himself, his history and the world. His relationship to space is characterized by the paradox of an opening to the shared world by keeping a distance from others. Sam gets punctually and cyclically involved in selected spaces that do not require any intimate social commitment, and stays on the lookout, from his home, for events in his neighborhood, his village, and world news. The Others participate in his distant integration into the community: his link with the mayor of the village validates his identity as a fully-fledged citizen, his family regularly invoked in his self-narrative is kept at a distance by monthly digital contacts, the neighbor's daily life must not be disturbed under penalty of divine punishment, etc. Sam claims a necessity of calm both inside and outside, as a support for a controlled intersubjectivity allowing the reconstruction of the self. Finally, the patient's temporality is structured by patience. À slow-now allows him to synchronize private and public paces. His esoteric beliefs give meaning to the cyclical repetition of events; his spiritual guides direct his life trajectory, promising him professional and relational dynamism from the age of forty. ConclusionÀ phenomenological approach as close as possible to the subjective experience of the person living with schizophrenia has made it possible to break loose from the social withdrawal symptom pointed out by psychiatric semiology. Positive withdrawal, as an active positioning of the subject both inside and outside the society, illustrates a process of recovery from the illness. By supporting an identity reconstruction through a dialectical tension between proximity and distance with the Other and the world, positive withdrawal reveals the importance of considering the paradoxical shape of recovery processes. It invites clinicians to free oneself from normative interventions motivated by a restrictive psychiatric empiricism.

Le syndrome psycholinguistique traumatique (SPLIT)

Le syndrome psycholinguistique traumatique (SPLIT)

"Social physiology" for psychiatric semiology: How TTOM can initiate an interactive turn for computational psychiatry?

Thinking through other minds (TTOM) encompasses new dimensions in computational psychiatry: social interaction and mutual sense-making. It questions the nature of psychiatric manifestations (semiology) in light of recent data on social interaction in neuroscience. We propose the concept of "social physiology" in response to the call by the conceivers of TTOM for the renewal of computational psychiatry.

Vers une approche physiologique de la sémiologie en psychiatrie. Partie 1 : approches RDC, DSM, RDoC et HiTOP

This first article, in a series of two, on the physiological approach of psychiatric semiology proposes to explore the place of physiology and clinical semiology in three systems of psychiatric classifications currently proposed in research: the Diagnostic and Statistical Manual of Mental Disorders (DSM), the Research Domain Criteria Project (RDoC), and the Hierarchical Taxonomy of Psychopathology project (HiTOP). For each of these systems will be presented the general principle, the link with physiology and semiology, and the main limitations. Physiology and clinical manifestation occupy a variable place and role in these three systems of psychiatric classifications. The DSM proposes a list of semiological criteria that are relevant to the clinical history of psychiatry, but the choice of these criteria and their organization remains guided by purely practical and nosographic issues with a very limited place for physiology. The RDoC project does not propose a list of semiological criteria. Its clinical and practical relevance is clearly questionable, but this project has the merit of emphasizing the importance of physiology in the medical approach of mental disorders. The HiTOP project does not in itself propose a list of semiological criteria, but proposes a hierarchical organizational framework of the nosography allowing to associate a set of signs and symptoms with supposed underlying psychopathological mechanisms. The challenge remains to coherently hang these psychopathological mechanisms to physiopathological mechanisms of mental disorders according to an integrative perspective of mental disorders.

Vers une approche physiologique de la sémiologie en psychiatrie. Partie 2 : perspectives offertes par la biologie systémique

This second article, in a series of two, on the physiological approach of psychiatric semiology proposes to explore the place of physiology and clinical semiology according to a systemic biology approach. While the approach of psychiatric semiology has been closely linked to the construction of contemporary classifications of psychiatric disorders, two approaches tending to break away from classical nosographies have been proposed: the psychosystems project and the Cambridge model. For each of these approaches will be presented the general principle, the link with physiology and semiology, and the main limitations. It will be proposed to include the psychosystems project as well as the Cambridge model from a systemic biology perspective that could reintegrate semiology as an essential level of the psychiatric disorder approach, between biological and social value. The issues of such biological and social constraints will be approached according to an epistemological approach, notably through the questions raised by neurophenomenology, in order to propose a perspective of clinical neurophysiology to psychiatry: that is to say of a neurophysiology that takes seriously the clinical knowledge historically constituted of psychiatry, but also a clinic that does not deny the advances in neurophysiology on the understanding of brain function.

Psychiatric comorbidities in temporal lobe epilepsy: A case study

IntroductionPsychiatric disorders frequently occur in patients with temporal lobe epilepsy (TLE) (70%). This combination further reduces the quality of life of patients as diagnosis is difficult and therapeutic opportunities are often missed.ObjectivesThe aim of this case study is to show the possible association between TLE and psychiatric semiology and its therapeutic implications.MethodsPresentation of the clinical case of Mr BH who experienced psychosis like symptoms, was finally diagnosed with TLE and put under anti-epileptic drugs.ResultsMr BH, aged 22, with no family or personal history, was admitted for aggressive behavior, self-harm, pyromania, and depression. Three years prior to onset of psychiatric symptoms, he reports episodes of pulsatile- left-temporal headache followed by hypertonic movements of the neck. Symptoms were intermittently followed by total amnesia or impaired consciousness. The patient explained symptoms by an inner presence that he called “his twin” and to whom he attributed those behaviors contrary to his will. The discovery of bilateral hippocampal atrophy in magnetic resonance imaging with a normal electroencephalography suggested the diagnosis of TLE with post-ictal psychotic disorders. Patient was put initially on diazepam and olanzapine with partial improvement. Association of valproate led to progressive but then complete disappearance of symptoms and so confirmed our diagnosis.ConclusionsIt is often difficult to attach psychiatric symptoms to epilepsy. The diagnosis should be done on a set of clinical, radiological and electrical arguments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

La sémiologie psychiatrique éclairée par les sciences cognitives

The psychiatric semiology presents complex historical and theoretical underpinnings that lead us to question the method to organize semiological terms. The current organization of semiology is mainly based on lists of symptoms in order to make diagnosis validated by international nosography and epidemiological approach. This “atheoretical” diagnosis approach lacks sometimes of accuracy to understand the mechanisms underlying the semiology and to develop individualized care support. We propose here to present a comprehensive and scientific semiology, based on the current nosology, but also allowing personalized care in psychiatry. This article highlights thus the role of cognitive science according to a fundamental distinction of cognition in two views. On one hand, cognition can be view as a content of thought in the context of cognitive behavioral therapies. On the other hand, cognition can be view as containing or thought processes in the context of cognitive remediation. Each of theses views highlight the role of cognitive science to develop a comprehensive, validated and personalized semiology in psychiatry.

The emergence of psychiatric semiology during the Age of Revolution: evolving concepts of 'normal' and 'pathological'.

This article addresses some important questions in psychiatric semiology. The concept of a sign is crucial in psychiatry. How do signs emerge, and what gives them validity and legitimacy? What are the boundaries of 'normal' and 'pathological' behaviour and mental experiences? To address these issues, we analyse the characteristics and rules that govern semiological signs and clinical elements. We examine 'normality' from the perspective of Georges Canguilehm and compare the differences of 'normal' in physiology and psychiatry. We then examine the history and the philosophical, linguistic and medical-psychiatric origins of semiology during the eighteenth and nineteenth centuries (the Age of Revolution). The field of rhetoric and oratory has emphasized the importance of passions, emotions and language as applied to signs of madness. Another perspective on semiology, provided by Michel Foucault, lays stress on the concept of 'instinct' and the axis of voluntary-involuntary behaviour. Finally, we analyse how statistics and eugenics have played an important role in our current conceptualization of the norm and therefore the scientific discourse behind the established clinical signs.

Le jardinier et le botaniste. Proposition d’une organisation minimale de la sémiologie psychiatrique pour l’étudiant en médecine

The medical student may have difficulties using accurate and organized terms of psychiatric semiology in order to structure its medical reasoning. The lack of consensus on the organization of psychiatric semiology as well as psychiatric syndromes is one reason for these difficulties. This article proposes a minimum psychiatric semiology of adult that should be used by a medical student. In the first part, called analytic semiology, it will be proposed an organization of psychiatric signs and symptoms based wherever possible on the current data of neuroscience and international consensus. A summary of the different terms of psychiatric semiology that the medical student should known will be proposed with a summary table. In the second part, called syndromic semiology, it will be examined one by one the basic syndromes that psychiatric semiology can identify without prefiguring their psychiatric and non-psychiatric aetiology. The medical reasoning applies in psychiatry will be summarized in as a synthetic support card.

Subjectivity in clinical practice: on the origins of psychiatric semiology in early French alienism.

The aim of this article is to contribute to the analysis of the origins of psychiatric semiology, which by emphasizing subjectivity in clinical practice, gave birth to psychopathology as the scientific and intellectual enterprise of alienism. In other words, beyond simple anatomical and clinical observation, there was an effort to 'listen to' and 'read' the patient's delirium. In essence, the basic thesis which this short paper seeks to defend is that, despite a growing anatomical and clinical mind-set and a clear interest in physically locating mental illness within the body, during the Romantic period, psychiatry was able to construct a semiology largely based on the experience of the ego, on the inner world of the individual. This makes it possible to establish, from a clinical perspective, that the birth of alienism - of psychiatry - must be situated within the framework of a modernity in which the culture of subjectivity was one of its most characteristic features.