Béatrice Gal

Stress and coping strategies in systemic lupus erythematosus: a review.

Systemic lupus erythematosus (SLE), a chronic and unpredictable disease accompanied by functional disability and a possible involvement of the central nervous system, leads to considerable psychological distress. A review of studies on stress and/or coping strategies in SLE since 1990 is presented. Many studies have investigated the place of major and minor stress and coping strategies in SLE morbidity (disease activity, organ damage, and physical and mental components of quality of life). Stress as a causal factor is not proved, but it seems to act as an exacerbating factor in disease activity and to have an impact on the quality of life. Coping strategies are more consistently associated with quality of life than with disease activity. Organ damage appears to be less associated with psychosocial factors than disease activity or quality of life. Despite the limitations of these studies, therapeutic interventions should be proposed to reduce psychological distress, to improve the quality of life and possibly to moderate the evolution of the disease.

Stress et stratégies d’ajustement dans le lupus érythémateux systémique

Resume Des repercussions psychologiques indeniables Le lupus erythemateux systemique (LES), maladie chronique, imprevisible, invalidante, pouvant atteindre le systeme nerveux central, a un important retentissement psychologique. La place du stress et du coping De nombreuses etudes ont tente de determiner la place des stress majeurs et mineurs et des strategies d’ajustement ou coping, dans les differents aspects de la morbidite du LES (activite de la maladie, chronicite lesionnelle et composante physique et mentale de la qualite de vie). Le role du stress comme facteur declenchant de la maladie n’est pas prouve, mais son role modulateur dans l’activite de la maladie et son retentissement sur la qualite de vie est probable. Le coping est davantage associe a la qualite de vie qu’a l’activite de la maladie. La chronicite lesionnelle semble relativement independante de ces facteurs psychosociaux. La necessite d’agir Malgre les limites de ces etudes, des mesures therapeutiques doivent etre proposees pour reduire la detresse psychologique des patients, ameliorer leur qualite de vie et peut-etre ralentir l’evolution de la maladie.

Anorexia nervosa hyperactivity-induced ischemic colitis (ANHIC): a new cause of anaemia.

Anorexia nervosa (AN) is a complex and multifactorial psychiatric pathologywith frequent acute or chronic somatic repercussions. It is classically considered that not only malnutrition, metabolic variations and numerous deficiencies in the restrictive sub-type of AN but also digestive lesions associated with other eating disorders sub-type (binge/purging AN, bulimia nervosa, rumination disorder, PICA) can lead to haematological changes [1]. In the literature, anaemia is more specifically and frequently described in AN and mainly as a result of medullary hypometabolism [2]. Despite common representations, cases of anaemia described in restrictive-type AN are not rare and are mostly transient andmoderately severe [3]. In contrast, the detection of some atypical biological stigmata such as a severe microcytic anaemia should raise the question of a differential diagnosis, or at least the co-occurrence of an organic pathology, such as inflammatory colopathy or coeliac disease [4]. Other cases of severe and profound anaemia, often developing very suddenly, can be observed in situations of extreme malnutrition with very low body weights and/or very rapid weight loss. The mechanism implicated is gelatinous degeneration of the bone marrow usually affecting the three cell lines, with a risk of multi-organ failure that is life threatening in the short term [5]. Finally, cases of severe anaemia have been described in Lasthénie de Ferjol syndrome, where the eating disorder is associated with severe psychiatric comorbidity [6]. We report the case of a female adolescent patient with AN presenting severe, recurrent episodes of red blood cell depletion, which did not fit the previously described situations, and could be related to a new and underdiagnosed clinical entity we called anorexia nervosa hyperactivity-induced ischemic colitis (ANHIC).

Rejet et fascination du corps. aspects psychiques et transculturels

Le corps est un espace privilegie ou viennent s’inscrire des conflits psychiques, par des marquages qui le signent ou des refus dont il fait l’objet. Il s’agit dans ce texte, au travers de l’etude de deux cas cliniques, d’examiner ces situations ou le corps devient un enjeu obnubilant et suscite une forme plus ou moins radicale de rejet. Depuis le cas d’Elegante, ou le corps se retrouve pris entre deux identites culturelles, jusqu’au cas de Jeanne, victime d’un rejet particulierement grave de son image corporelle, nous voulons essayer de penser au mieux ces moments ou le corps fait probleme, sur fond de conflits psychiques.