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Often seen as the counterpart to complaints, thank-you and compliment messages received in hospitals tend to attract less attention. However, they often contain narratives of care experiences and allow patients or relatives to express a wide range of needs. Through writing, they may seek to bring closure to a period of vulnerability, maintain a connection with healthcare staff, express or manage a symbolic debt, or share their experience of care. Far from being simple gestures of appreciation, thank-you and compliment messages invite deeper reflection on the expectations and intentions of those who write them. Souvent perçus comme l’opposé des plaintes, les remerciements reçus à l’hôpital ne font pas l’objet de la même attention. Ils contiennent pourtant de véritables récits d’expérience et permettent aux patient-es ou à leurs proches d’exprimer une diversité de besoins. À travers leur écriture, celles et ceux-ci cherchent parfois à clore une période de vulnérabilité, à maintenir le lien avec les équipes soignantes, à exprimer ou gérer une forme de dette symbolique ou encore à témoigner de leur vécu de la prise en charge. Ces remerciements vont donc bien au-delà de la simple expression de reconnaissance : ils ouvrent une réflexion sur les attentes et les intentions de celles et ceux qui les formulent.
The randomized SIPRéS study, conducted at Montpellier University Hospital, compares an outpatient nursing follow-up program aimed at preventing post-hospitalization suicide recurrence with standard care. Although it has no significant impact on recurrence, this program leads to a better therapeutic alliance and increased spontaneous use of care. This hospital nursing and paramedical research program also promotes the professionalization of nurses and has led to the creation of innovative care pathways in psychiatric emergency departments.
The Psy-Belt program (brief psychiatric care linked to the local area), developed by the Nord-Ouest Val-d'Oise hospital with the support of the Île-de-France regional health agency, aims to improve access to outpatient psychiatric care. Positioned at the beginning of the care pathway, it offers rapid assessment and intensive short-term follow-up by psychiatrists and advanced practice nurses (APNs). Despite limited human resources, it illustrates an innovative organizational approach aimed at streamlining mental health care pathways in a region under pressure and takes full advantage of the new skills offered by the arrival of APNs in psychiatry.
Although people with mental disorders are more often victims of violence than perpetrators, psychiatric dangerousness remains a widely publicized and controversial topic. It is important to examine the epidemiological reality and address the psychodynamics of dangerous behavior, as well as its risk factors and assessment tools, but also to discuss traditional approaches to care, as any therapeutic approach must respect the uniqueness of each patient.
Les outils de dépistage actuels de la consommation néfaste d’alcool ne correspondent plus aux directives récentes liées aux risques de l’alcool pour la santé. Afin de remédier à la situation, le groupe de l’Initiative canadienne de recherche sur les impacts des substances psychoactives (ICRIS) a mis à jour les recommandations relatives au dépistage de la consommation d’alcool à risque élevé et du trouble d’utilisation de l’alcool (TUA) du guide de pratique clinique national de 2023. MÉTHODES : À la suite d’une analyse documentaire systématique des textes publiés du 1er janvier 2013 au 24 février 2023 ayant porté sur les outils de dépistage de la consommation d’alcool à risque élevé et du TUA, un comité national multidisciplinaire, composé notamment de personnes ayant une expérience passée ou actuelle, a élaboré les recommandations mises à jour. Nous avons évalué les recommandations et le degré de certitude des données probantes à l’aide de l’approche GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Nous avons utilisé l’outil AGREE II (Appraisal of Guidelines for Research and Evaluation II) et les principes de divulgation des intérêts et de gestion des conflits (Principles for Disclosure of Interests and Management of Conflicts in Guidelines) publiés en anglais par le Guidelines International Network pour nous assurer que la mise à jour répondait aux normes internationales de transparence, de qualité élevée et de rigueur méthodologique. Reconnaissant que la contrainte de temps est l’obstacle le plus fréquemment cité en ce qui concerne le dépistage universel des risques et des problèmes liés à l’alcool, nous avons élaboré 5 recommandations comprenant une méthode de dépistage simple, afin de repérer tant la consommation néfaste d’alcool que les problèmes graves liés à l’alcool et d’y remédier. On recommande entre autres de demander à tous les patients et toutes les patientes quelle est leur consommation d’alcool et de fournir un soutien éducatif aux personnes qui consomment au-delà du seuil de faible risque des Repères canadiens sur l’alcool et la santé. Nous proposons un algorithme de dépistage simple pour optimiser une intervention et la personnaliser, y compris l’évaluation de la possible présence d’un TUA. INTERPRÉTATION : Les recommandations actualisées en matière de dépistage représentent une approche pragmatique qui permet de gagner du temps et devrait devenir une ressource pour le dépistage universel des risques et des problèmes liés à l’alcool. Les recommandations simplifient le processus visant à repérer les besoins en matière de santé des personnes qui consomment de l’alcool de façon dangereuse ou qui pourraient avoir des problèmes graves liés à l’alcool, ainsi que le processus permettant de trouver des solutions à ces préoccupations.
In psychiatry, mental exhaustion among caregivers stems from exposure to suffering, suicide risk, and violence, as well as organizational constraints. Despite numerous support systems, teams describe the services available as unclear and difficult to access. After describing the gray area of exhaustion, between individual experience, institutional norms, and demands for resilience, guidelines for framing digital or artificial intelligence projects presented as support for well-being can be proposed. An action plan by the Strategic Partners Initiative for Data and Digital Health, based on operational data to identify team tensions, serves as a basis for setting the minimum requirements for an ethical digital companion.
People with autism in complex situations often have somatic needs that go unrecognized. An analysis of a prospective one-year activity dataset highlights the essential role of advanced practice mental health nurses: clinical assessments, prevention, care pathway coordination, and team support. The integration of somatic vigilance, understanding of the neurodevelopmental profile, and care organization appears to be critical. A clinical case study illustrates the impact of this role in the early detection of a serious complication and in ensuring continuity of care.
The development of soothing care to avoid coercion and the implementation of psychosocial rehabilitation care are integral to our mental health policies. The question arises as to what extent these approaches conceptually contribute to alleviating tensions within long-term inpatient units. Emotion regulation is also a key focus in managing interpersonal relationships. Description and feedback on the implementation of a combined program of psychoeducation and social skills training within Epsylan's discharge preparation units.
Suicide is a major public health issue. Efforts to prevent it must begin as soon as hospitalization. Brief mental health interventions and contacts are known to be effective. The HOPAIR study proposes an innovative combination of peer support intervention and the Hope Box tool, followed by a reminder postcard sent to suicidal individuals hospitalized in psychiatric crisis units at two research centers in Lyon. Focusing on the resources of those affected, hope, and recovery, this study highlights the work of peer support workers and advanced practice nurses while offering encouraging prospects in the field of suicide prevention.
The self and its disorders in schizophrenia have been studied extensively over recent decades. Much of this literature is grounded in a bipartite understanding of the self, distinguishing the pre-reflective, minimal self from the reflective, narrative self. However, few studies have systematically examined the links between disturbances at these two levels of self. This integrative review addresses this gap by analyzing both theoretical and empirical contributions. Three theoretical models are described. The Structural model posits that minimal self-disorders hierarchically give rise to narrative self-disturbances and the schizophrenia phenotype, with a primarily pathogenic focus. The Dialectical model emphasizes reciprocal interactions between minimal and narrative self-disturbances, generating the schizophrenia phenotype with both pathogenic and salutogenic implications. The Contextual model highlights social, territorial, and biological dimensions of the self and its disorders in context. Empirical studies specifically addressing the mechanistic links between minimal and narrative self-disturbances remain scarce and preliminary. Overall, the literature appears preliminary and occasionally speculative, yet it suggests several promising avenues for future research and clinically relevant applications. This article is categorized under: Philosophy > Consciousness Psychology > Theory and Methods.
Drawing on her recent experience as a child psychiatrist in the perinatal psychiatry department of Strasbourg University Hospitals, the author offers clinical and institutional insights into the environment of babies receiving perinatal psychiatric care. For these vulnerable babies, or those at risk of becoming vulnerable, joint care can, for a time, be considered part of their environment. Shared reflection and team dynamics are therefore particularly valuable.
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Generative artificial intelligence, particularly through large language models (LLMs), is attracting growing interest in healthcare. While the literature and applications have mainly focused on supporting medical diagnosis, a major and more immediate opportunity generally associated with a lower level of clinical criticality, lies in reducing the time devoted to clinical documentation. In nursing practice, the drafting of reports, letters, handover notes, and summaries represents a substantial and time-consuming workload. This article presents the contributions and main limitations of LLMs for audio-to-text transcription, automated structuring of nursing consultation reports, and assisted drafting of clinical correspondence.
Psychotherapy, the standard treatment for borderline personality disorder, is often difficult to access, and its application in the field is hampered by neurocognitive and psychosocial impairments. This lack of care contributes to the psychosocial stagnation of vulnerable individuals, which is costly for society, particularly in terms of repeated visits to emergency rooms and prolonged hospitalizations. This context also leads to professional burnout and harmful stigmatization. Follow-up care aims to limit these episodes by anticipating emergency situations and gradually reintegrating patients into a more personalized care pathway.
For the past five years, the Rouvray Hospital Center has offered a patient therapeutic education program designed for individuals with borderline personality disorder. Based on an integrative therapeutic approach, the program aims to strengthen participants' internal resources and autonomy in order to facilitate their reintegration into social, emotional, and professional life.
This study explored the perceptions of Paris firefighters regarding psychiatric emergency interventions in a context of increasing collaboration with the psychiatric mobile emergency medical service in Paris (SAMU-psy). An online questionnaire was distributed to Parisian firefighters working in central Paris from May to June 2025. Responses were analyzed descriptively. In total, 924 firefighters responded. They reported near-daily exposure to psychiatric situations, often perceived as complex. The most frequently encountered cases involved behavioral disturbances related to substance use (82.6%) and suicidal ideation (54.6%). Firefighters described feelings of mistrust (84.1%) but also empathy (53.3%) during these interventions. Nearly 42% reported lacking specific knowledge, and 44.5% expressed a desire for further training. Reported challenges included communication with patients, especially when care was refused, coordination with other emergency services, and emotional exhaustion. Overall, 15.8% of firefighters had previously participated in a joint intervention with the SAMU-psy. These collaborations were generally considered helpful for de-escalation or decision-making support. This study highlights the tensions, needs, and perceptions firefighters experience in psychiatric emergency situations in Paris. It emphasizes the relevance of enhanced training, more systematic access to specialized psychiatric support, and improved inter-institutional coordination to strengthen prehospital psychiatric emergency care.