Pédopsychiatrie

The pédopsychiatrie is a particular branch of the Psychiatrie applying to the human beings of the birth at 15 years (or sometimes approximately 20-25 years). The doctors psychiatrists practitioner the pédopsychiatrie are called Pédopsychiatres.

The age limits higher reception in pédopsychiatrie, as in pediatry was defined by the hospital use which observes that at 15 years and three months, puberty being finished, the body being adult, the care (and what goes hand in hand, financial means and the especially human ones) are dealt with by the adult services. The passion and the specific development of new structures associating the assumption of responsibility of teenagers and young adults (15-25 years) do not make it possible to generalize this higher limit. France in addition presents a lack of hospital places with reception day and night (services known as " with full temps") of pédopsychiatrie…

Like psychiatry, it is a discipline of borders (Médecine, Psychologie, pedagogy). But moreover it relates to beings under development and becoming, which makes delicate the appreciation of the relevance of the clinical pictures which can so quickly change. Like psychiatry, it is, as connects medicine, in the obligation to be able to make the dead end on the existence, scientifically problematic, of the Esprit, the Psyché.

Like psychiatry, it is pulled about between a vision privileging what one can call the “hardware” (Génétique, Neuroanatomie and Neurophysiologie, Neuropsychologie, neurosciences…) and another stressing the “software” (Processes of training, processes psychological, Psychoanalysis of the children; Psychoanalysis of the teenagers). It is thus an impossible discipline, the more so as she addresses herself to the child (or the teenager), her apparent object, but also with the parents, like the social entourage, of which the school.

The pédopsychiatrie, or psychiatry of the Child and the Adolescent (also called Adopsychiatrie) is marked it also by the “modern” attempt to impose in an hegemonic way a descriptive classifying design by symptom, named “turbid” (turbid obsessifs complusifs, Hyperactivité and deficit of attention…) with the detriment of a classification per type of organization of the mental processes (organization Psychotic, nevrotic…). It is simply the reflection of the current ideological domination.

The pédopsychiatrie takes its rise, in France, around the school of Salpêtrière, between the two world wars, under the impulse of Georges Heuyer which émancipe at the same time of the psychiatric models centered on Asylum, and of pedagogy. It profited, in the years 1960-1980, of the contribution of the Psychanalyse, then in the years 1990-2000 of the primacy of the visions centered on the disorder and the access neuro-scientist.

The pédopsychiatrie questions the ideological models also harshly. It misses a clear anchoring and a simple way of cause for purpose between the genetic anomalies, anatomical and physiological, and their translation in term of disorders or conduits: it is the absence of the correlation anatomo-private clinic (put in prospect for the diseases and affections with the modifications for the bodies, of fabrics) suitable for medicine. The correlations between behaviors and/or disorders and cerebral imagery should not misuse: what appears in serious disorder also appears in anomalies or characteristics of cerebral operation. One is the transfer of the other, and does not bring to the bottom any invalidation or unspecified confirmation to an assumption. Psychism niche in the brain, its disorders also, nothing is immaterial if it is not perhaps the question of the direction of the symptoms and of lived subjective.

The pédopsychiatrie is a discipline where the party taken ideological is often in the foreground. Same, supposed classifications being objective, often translate for this party taken their authors. It is that the discipline cannot exist without the constitution of a modeling of pédo-psychiatric pathology. The modeling term being included/understood within the meaning of modelings economic or weather, i.e. the test to seize the evolution of complex systems of interactions between elementary forces however perfectly locatable (currency, exchanges, price, quantity for the economy, pressures, masses of air and steam for example for meteorology) with the assistance sometimes of the creation of abstract objects but which, in any case, make possible of the explanatory models. This modeling (psychiatric theories) is certainly ideological, but it is essential tools. The posted absence of such a modeling (system objective or atheoric…) is highly suspect. The key modeling to lie it in classification suggested, from where current polemics.

The name for example of “disorders obsessifs-compulsifs” instead of that “of obsessions” even of “Obsessional neurosis”, far from being without impact, directs the things implicitly. What counts in the “T.O.C” they are precisely the visible demonstrations, especially when they are invading and awkward. The goal of the doctor is to make them cease. The criterion of improvement, even of cure will be the reduction, even the disappearance of the disorders, as soon as possible. If one evokes a “obsessional neurosis”, one will postulate that the demonstrations are the reflection of a certain organization of psyché, having causes and an internal psychic articulation. The goal of the treatment will be the modification, even slow or incomplete, of this psychopathological organization. The criterion of improvement will be the modification of the organization, even if the sedation of the disorders is an important component.

If current French classification (French Classification of the Mental Disorders of the Child and the Teenager) is of psychoanalytical inspiration, the International Classification of the Diseases, and American classification (DSM IV) are the echo of a vision per existing “disorder” by them same, except notable for the invading disorders of the development, which are detached as a clinical entity, whereas the tables observed are rather disparate.

In all the cases, it is the clinical access which constitutes the richness of the pédopsychiatrie. Clinical access whose main thing is the observation, listening and the dialog with the young patients and their families.

The treatments pedopsychiatric are primarily psychotherapeutic and adaptive (living conditions, relations family, school insertion), more rarely chimiotherapic. But one is the success of the promotion of amphetaminic in the hyperactivity, as well as antidepressants in the depressive states.

Principal affections that the pédopsychiatrie meeting are very varied. They go from the temporary problems and/or intensity moderate (disorders of the food, of the sleep, enuresis, encopresy, anguishes, sadness), to very serious tables: invading disorders of development, such autism, mental health disorders serious, such inhibition, agitation, opposition, serious disorders of the behavior, in particular at the school. There will be guard to omit intellectual deficiency and his multiple causes which, very often dominates or decorates the clinical pictures observed. In all the cases, they are disorders occurring in the evolution of the child, and modificant with that Ci.

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