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AbstractThis article examines the debate surrounding the concepts of personality disorders through a review of the Medline literature on personality disorders definitions, psychometric studies, etiologies, categorical versus dimensional as well as trait-state issues and stability of diagnosis. It is suggested that clinicians will gain better diagnosis accuracy and more refined treatment planning if they understand the conceptual difficulties belonging to personality disorders. Beyond the knowledge of DSM diagnostic criteria, they should familiarise themselves with notions of traits, dimensions and temperament as these paradigms help to follow current developments in personality etiology research.

AbstractOne of the ways of finding out where we are going consists of asking ourselves where do we come from. Here the author uses a historical approach to give an overview of the problem of insanity in Québec. The author discusses how people view insanity, its causes and treatments and the characteristics of the organizations (actors, values, knowledge, human and financial resources) that have met its challenge. The author describes two periods: the period of bureaucratic rationalization (the Bédard and Castonguay-Nepveu reports) and the period of community responsibility. Rather than presenting anecdotes, the author concentrates on raising a number of questions that can help unravel the debate on forming a policy on mental health.

SUMMARYThis article challenges the perenniality of psychiatric power in the western world. As one is crazy only in relation to a given society, we find it legitimate to ask whether psychiatry, in spite of its scientific premises, has in over 100 years of practice really contributed to improving existence of the individual that have received psychiatric treatment. In psychiatry we have merely gone from physical straightjacket to a chemical straight]acket.

SUMMARYThis study focuses on the psychological impact of divorce on ex-spouses. Data was gathered through a questionnaire that was handed to 127 people of which 97 were women and 30 men. Most subjects were selected from a list of names supplied by organizations offering assistance to separated and divorced people. Results at first show the socio-demographic characteristics of the people consulted. A brief review of the correlative analysis data then provides an overview of the variables likely to affect or help improve the social and psychological experience of people confronted with a broken relationship. Are therefore studied in succession aspects such as the adaptation in detail of ex-spouses following divorce and the emotional attachment of the ex-partner. Results are discussed in function of various clinical approaches that could make it easier for ex-spouses to adapt to the changes in lifestyle at the outcome of divorce.

ABSTRACT In this article, the author presents the main results of an exploratory clinical study aimed at identifying the adaptation mechanisms used by chronic psychiatric patients. These patients had been treated and followed by an external clinic located in an underprivileged urban environment. Upon the analysis of social worker's observations, the author was able to pinpoint 39 adaptation mechanisms within five areas of daily life: economical, residential, temporal, interpersonal and therapeutic. In conclusion, the author emphasizes on the six operating parameters of these adaptation mechanisms.

ABSTRACTIn psychiatry, request to evaluate treatments are increasingly frequent. Based on a Geneva research project dealing with the evaluation of crisis treatment and its follow-up over a two-year period, the authors examine the various steps involved in the evaluation of treatment prescription and followup, from the theoretical and methodological points of view.

AbstractAlthough neuroleptic medication is clearly effective, there is still an important role for psychological interventions for people with psychosis. Figures vary, but it can be estimated that between one quarter and one half of people with a diagnosis of schizophrenia experience persistent symptoms such as delusions and hallucinations, which cause distress and interference with functioning, despite taking medication (Fowler et al. 1995). Relapse occurs commonly even amongst patients who do adhere to medication regimes, and many people are reluctant to take long-term medication, because of its unpleasant and even disabling side-effects. In recent years, there has been a growing interest in developing cognitive behavioural therapy for those people with psychosis who continue to experience psychotic symptoms despite ongoing treatment with anti-psychotic medication. Cognitive behaviour therapy for psychosis seeks to address directly those patterns of behaviour, thinking and emotional response which underpin and maintain severe and chronic delusions and hallucinations.

SUMMARYThis study lies within the framework of an earlier descriptive study related to psychiatric problems in the Montreal métropolitain area. That study showed that there is a high level of re-utilization of emergency services by people who have had or still have serious mental health problems.This phenomenon is investigated in the present study with a view firstly for describing the incidence of the re-utilization of emergency services in the 6 A social/health region and secondly, for showing the contribution of certains factors that, from the viewpoint of socio-psychiatric features of a target group of patients, are presupposed determinants of re-utilization.The analysis of a collection of socio-demographic and clinical is based on a sample of 1 259 patients re-utilizers of emergency resources. On one hand, such an analysis provided a certain number of factual data for describing the types of re-utilization profiles and identifying the group of patients concerned. On the other hand, the proposed conceptual pattern aims at situating the various factors involved and contributes therefore to defining a perspective that would consider the dynamics various components of the re-utilization (general model).Our hypothesis to the effect that the social-demographic and clinical variables associated to the socio-psychiatric profiles of known patients in the public network only accounts for a weak proportion of the re-utilization, is confirmed.This important conclusion suggests that the other field of determination, particularly the functioning of our system of care distribution (continuity of care, follow up, procedures theories within the framework on non-institutional services) and the difficulties of réintégration encountered by people identified as being «mental» (community's tolerance) would be the most determinant factors of re-utilization.The present discussion proposes several ways of considering the necessity for developing a general problematic based on the fact that the phenomenon of re-utilization is both the result of a special type of interdependence between the system of care distribution and the identified patient in the network, as well as the result of the interdependence between this person, his/her illness and his/her social setting.

AbstractIn Québec, a consensus appears to have developed over the last few years around the need to develop community-based resources in mental health. However, the concept of community resources is fragmented: there is a conceptual distinction between Alternative and Intermediary Resources, both of which are located outside the walls of the institution, but which have different objectives, and suggest different means for supporting the mentally disturbed in the community. Attempts to operationalize these concepts have tended to have the effect of masking their conceptual particularity. In this article, the conceptual distinctions - as they have developed in the Québec context - are clarified, and the implications of erasing them are discussed.