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AbstractThe new sociocultural realities of Québec society provide the opportunity to rethink practices in the field of mental health, particularly in regards to clinical assessments. Although remaining in part objective, clinical assessments are invariably strongly coloured by the sociocultural contexts where theoretical approaches and practical assessment tools are developed. Clinicians' institutional mandates also influence the ways in which they consider and proceed with the process of assessing. This article highlights the necessity of taking into account institutional and political dimensions in addition to simply recognizing the cultural differences at play. One means of facilitating this understanding is a “transcultural” and “inter-institutional” seminar for clinicians from various institutions (CLSCs or Youth protection agencies) with distinct mandates that revolves around case discussions concerning people of diverse cultural origins.

SUMMARYThis article is part of a general outline on the Psychiatry of Work, and with the help of case histories, looks upon a sector not well researched in the literature: the direct or indirect use of the psychiatric file in the firing of an employee. The first case presents a patient known as such, who had become too ill to reintegrate his job and who needed help having his fundamental rights recognized. In the second case, the employer, on the strength of a psychiatric evaluation he himself had ordered, fired an employee, invoquing a refusal on his part to accept treatment. Testimonies revealed afterwards that abnormal pressures were used on this employee. The author concludes that in similar cases, caution is necessary especially when the demand for an evaluation comes from the employer. He wishes that in an overall perspective of social réintégration, the therapeutic teams give more attention to the réintégration in the work field.

AbstractThis article describes the process of implementation of an internal intensive rehabilitation program at Douglas hospital for people with severe mental disorders. A discussion of contemporary paradigms of rehabilitation implies the integration of biological and psychosocial perspectives in the characterization and treatment of the pathology. The discussion of the reorganization of the entire rehabilitation services of the Program for severe mental disorders leads to specifying the organizational and regional context of the implementation. The axes of implementation in priority are the following : analysis of needs, training, reorganization of work and modification of the setting of care. These activities are implemented in reference to scientific developments that are empirically relevant and assessed regularly. Future challenges include the pursuit of integration of treatment models, of settings and services within the context of the hierarchy of mental health care in Québec.

SummaryIt has long been admitted in sociology that the psychiatric destiny of an.individual could be seen in terms of "careers" which lead to the psychiatric institution. The research described here takes up the notion of careers, but applies it to a situation in which the number of possible careers has multiplied. This is based on the supposition that illness and its associated behavior patterns be conceived of in terms of individual strategies, that is, of opportunities to be taken advantage of. This research was carried out by using the method of life histories which were constructed by means of repeated in-depth interviews. The histories of thirty-five patients were analyzed in relation to H. Becker's notion of "saturation" and Lmdesmith's "negative case". The analysis also called upon the researcher's clinical intuition. A number of elements were isolated - defined either in psychiatric terms or in social terms - which were then used to formulate a typology of psychiatric careers and of their underlying strategies.

AbstractThis essay presents a perspective on intervention in psychiatric consultation based on the patient's subjective experience as supported by Kendler in 2005 in the American Journal of Psychiatry in his position against biological reductionism in psychiatry, distinguishing the psychic approach from the biological. The paper presents aspects of the setting and major features of the assessment in the consultation process, then proceeds to discussing principles of intervention as to specify dimensions of the psychiatric intervention in this particular context.

AbstractDiscontinuing the use of benzodiazepine medication can represent a difficult task for some people. High rates of relapses are associated with attempts to stop their use. However, it remains difficult to explain why some people fail in their efforts. The current knowledge suggests the involvement of a psychological component in the difficulty to stop benzodiazepine medication (BZD). Expectations of people who consider stopping their medication has been mentioned as a possible explanation of the failure of the withdrawal process. However, no empirical study has examined the effect of these expectations on the appearance of symptoms during withdrawal or its outcome. This article presents the development of an instrument aiming at assessing personal expectations regarding discontinuation of benzodiazepine medication with individuals who suffer from anxiety. It presents preliminary data related to the clinical validity of items. From 50 initial items, 24 have been eliminated following a first test with some participants. Among 26 chosen items, it has been observed that 8 items (for example, nervousness/anxiety, cognitive capacities, mood) could discriminate between participants having succeeded and those having failed. Generally, it has been observed that participants who have succeeded had expectations that were significantly more positive than people who had failed in their attempt to stop. These preliminary results tend to support the hypothesis according to which negative expectations would harm the BZD withdrawal process. However, these results must be replicated with a greater number of participants.

AbstractThis essay takes its support on the study of concepts of intentionnality and life projects and their use in the rehabilitation of people with borderline personality disorder (BPD). It considers that these people are disconcerted and disconcerting and the pertinence of envisaging new ways of helping them reconstruct a sense of their existence. Inspired by constructivist approaches that recognize the constant interaction of the subject with his environment and the duality of things, this reflection leads to the necessity of exploring the intentionnality of people with BPD and develop their reflexive capacity in order to allow the progressive emergence of a life project. This recovery process is part of an approach where hope and mobilization of the person's strengths take an important place.