Papers by Philippe Raynaud
Resume Nous presentons ici un modele de soins de sante mentale, porte par l’organisation non gouv... more Resume Nous presentons ici un modele de soins de sante mentale, porte par l’organisation non gouvernementale Saint-Camille-de-Lellis. Au Benin, ce dispositif est deploye sur la quasi-totalite du territoire national sur un mode qui rappelle l’organisation francaise du secteur. Il est conforme aux recommandations de l’Organisation mondiale de la sante. Il fait appel a des ressources humaines locales et a des volontaires internationaux. Il est finance par des dons prives. Nous souhaitons montrer comment une initiative locale a permis de mettre en place une offre de soins psychiatriques accessible, perenne et efficiente a l’echelle d’un pays, dans un environnement difficile marque par la grande pauvrete et l’absence de protection sociale sans aucune intervention de l’Etat.
French Journal of Psychiatry, 2019
Dans un contexte ou les soins psychiatriques font l’objet de multiples carences, l’enjeu de la di... more Dans un contexte ou les soins psychiatriques font l’objet de multiples carences, l’enjeu de la diffusion des connaissances par le personnel paramedical pour une approche communautaire est majeur. Pourtant, les enseignements actuels ne semblent pas permettre le transfert et l’application des competences en pratique clinique quotidienne, et la plupart des soignants semblent demunis face aux personnes souffrant de troubles mentaux. Quatorze soignants de l’Organisation non gouvernementale beninoise Saint-Camille (ONG SCL) ont ete interroges afin de prendre connaissance des representations de ces derniers vis-a-vis de la maladie mentale rapportees par les soignants avant et apres la formation par la SMAO. Avant la formation SMAO, ils n’etaient que 5 a declarer avoir recu une formation en sante mentale, dont un seul declarait en avoir compris le contenu. La formation a permis la deconstruction des prejuges portes aux malades mentaux et semble pouvoir rapidement mobiliser les soignants et largement modifier leurs representations de la psychiatrie. En effet, l’ensemble des soignants n’avaient plus peur des malades, etaient tous convaincu de l’organicite des troubles mentaux et des possibilites de traitements medicamenteux. Cette demystification de la psychiatrie semble concourir a son insertion dans des soins communautaires de proximite. Au-dela des multiples theorisations dont peut faire l’objet la specialite, une formation simplifiee n’est pas une formation degradee, si celle-ci s’adapte au personnel et au terrain qu’elle cible.
International Journal of Clinical Psychiatry and Mental Health, 2020
La loi du 2 juillet 2011 a profondement modifie les rapports sociaux a l’œuvre autour de la mise ... more La loi du 2 juillet 2011 a profondement modifie les rapports sociaux a l’œuvre autour de la mise en place et de l’organisation des soins sans consentement en France pour deux raisons principales : la rencontre systematique avec le juge des libertes et la consecration des soins ambulatoires contraints. A travers l’experience du conseil local de sante mentale de Prades, nous avons cherche a savoir si l’integration de professionnels de la sante mentale au sein d’une cellule de coordination de la ville avait un impact sur le nombre de mesures de soins sans consentement prises a l’echelon municipal et quels etaient les ressorts supposes des changements observes.
Frontiers in Psychiatry
Background: The psychophysiological changes for individual suffering from chronic post-traumatic ... more Background: The psychophysiological changes for individual suffering from chronic post-traumatic stress disorder (PTSD) raise to the questions of how facilitate recovery and return to work. Negative alterations in neuro-cognition remain a complaint for patients and participate to long-term functional impairments. Neurological soft signs (NSSs) appear as a candidate for better understanding these complaints. They have been reported in several mental disorders. They are found in several behavioral and/or neurocognitive disorders and are taken into account by psychiatric rehabilitation programs to support recovery. As few studies evaluate NSSs in PTSD, our exploratory study aims to assess NSSs in chronic PTSD and their relationships with PTSD severity. Method: Twenty-two patients with a clinical diagnosis of chronic PTSD were evaluated in terms of PTSD severity (post-traumatic checklist scale, PCL5), NSSs (NSSs psychomotor skills scale, PASS), and well-being upon arrival to the hospital and compared with 15 healthy subjects. Statistical non-parametric analyses assessed the relationships between these variables. Results: PTSD subjects exhibited higher NSSs compared with healthy subjects. NSSs were positively associated with PTSD severity, with negative alterations in cognition and mood, and with impairment in well-being. They were higher in women compared with men. No impact of age was found. Three groups were identified based on the severity of the PTSD. Severe PTSD exhibited NSSs characterized by motor integration alterations. Conclusions: This pilot study suggests that NSSs might be a biomarker of PTSD severity. This proof of concept highlights the need for further research for better evaluating the clinical neuro-functional impairment. This will be helping for defining neurological remediation for promoting PTSD recovery.
Catheterization and Cardiovascular Diagnosis, 1997
This study was undertaken to determine the feasibility and safety of coronary stenting in acute m... more This study was undertaken to determine the feasibility and safety of coronary stenting in acute myocardial infarction (AMI). In AMI, primary percutaneous transluminal coronary angioplasty (PTCA) is accepted as the preferred method of reperfusion for patients presenting at highly experienced centres. Until recently, however, stenting has been avoided during AMI because of a potential high risk of thrombosis. This prospective observational study carried out in 20 centres and included 648 consecutive patients who underwent PTCA with stent implantation for AMI. Of these 648 patients, 269 (41.5%, Group 1) were dilated early (< 24 hr) after the onset of the symptoms (75% treated by direct PTCA) and 379 (58.5%, Group 2) were dilated between 24 hr and 14 days after AMI. Combined therapy with ticlopidin and aspirin was used after the procedure. Bailout stenting occurred more often in Group 1 than in Group 2 (17% vs. 9.5%)(P < 0.05). Angiographic successful stenting was similar in both groups of patients (96% vs. 97%). During the hospital follow-up period, stent thrombosis occurred in eight patients (3%) in Group 1 and in six patients (1.6%) in Group 2 (NS). There was 14 deaths (5.2%) in Group 1 and 11 deaths (3.9%) in Group 2 (NS). After multivariate analysis bailout stenting was identified as the sole predictor of stent thrombosis (P < 0.0001). Vascular access-site complications occurred in six patients (1%) with no difference between the two groups. This study indicates that patients who receive a coronary stent in AMI can be managed safely with antiplatelet therapy. Randomized studies are needed to determine the precise indication for coronary stenting as an adjunct to primary PTCA.
The Journal of Trauma: Injury, Infection, and Critical Care, 1990
1,026 multiple trauma patients (P) were compared to P with chest injuries (PCT) (407). Severity i... more 1,026 multiple trauma patients (P) were compared to P with chest injuries (PCT) (407). Severity indices were related to type of thoracic injury and mortality. The Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Trauma Score (TS), CHOP, and the Respiratory Index (RI) were used. The mortality rate of P was 27.1% but increased to 32.9% for PCT (p less than 0.05). We noted that mortality rate was highly dependent on major chest trauma: 68.6% for flail chest (FC), 56% for lung contusion (LC), 42.3% for hemothorax (HA), and 38.1% for pneumothorax (PN). ISS and RI scores for PCT survivors were greater than ISS + RI scores for P survivors (p less than 0.05 and p less than 0.01). ISS values for LC, HA, and PN PCT survivors were greater than the ISS of P survivors (p less than 0.01). Nonsurviving PCTs, especially those with lung contusion, showed a highly significant increase in ISS and RI scores.
Journal of the American College of Cardiology, 1996
The American Journal of Cardiology, 1991
Pathophysiology of unstable angina involves spasm, plaque rupture, activation of platelets, and c... more Pathophysiology of unstable angina involves spasm, plaque rupture, activation of platelets, and coagulation. The incidence and frequency of intracoronary thrombus formation are presently under active assessment in order to establish the potential benefit of thrombolytic therapy. A preliminary study was conducted in patients admitted in our coronary care unit for unstable angina with typical clinical and electrocardiographic criteria and with early coronary angiogram. After exclusion of 4 patients with left main coronary stenosis or contraindications for thrombolysis, 16 patients received thrombolytic infusion and 14 underwent a second coronary angiogram. Seven patients had an intracoronary thrombus (6 nonocclusive, 1 occlusive) and at the second angiogram only 3 nonocclusive thrombi were modified (1 disappeared, 2 were reduced). Moreover, the quantitative Coronary Angiography Analysis System (CAAS) in the 11 cases suitable for analysis did not show any significant changes, especially in the Ambrose type IIB lesions. In-hospital clinical outcome was not influenced by thrombolytic therapy (5 ischemic recurrences, 1 fatal myocardial infarction, 4 emergency and 4 elective revascularization procedures). This short series is in agreement with the literature data. Only one third of patients with active unstable angina remains refractory to conventional therapy. The transient benefit of thrombolysis is limited to patients with demonstrated intracoronary thrombi. Clinical or angiographic improvement are not always in correlation and until now do not seem able to prevent short-term recurrences or the need for revascularization procedures.
Cerebrovascular Diseases, 2001
A combination of low-dose aspirin with anticoagulants may provide better protection against throm... more A combination of low-dose aspirin with anticoagulants may provide better protection against thromboembolic events compared to anticoagulants alone in high-risk patients with atrial fibrillation. Evaluation of the preventive efficacy against nonfatal thromboembolic events and vascular deaths of the combination of the oral anticoagulant fluindione and aspirin (100 mg) in patients with high-risk atrial fibrillation. A multicenter, placebo-controlled, double-blind, randomized trial was conducted at 49 investigating centers in France. Atrial fibrillation patients with a previous thromboembolic event or older than 65 years and with either a history of hypertension, a recent episode of heart failure or decreased left ventricular function were included in the study. Patients were treated with fluindione plus placebo (i.e. anticoagulant alone) or fluindione plus aspirin (i.e. combination therapy), with an international normalized ratio target of between 2 and 2.6. The combined primary endpoint was stroke (ischemic or hemorrhagic), myocardial infarction, systemic arterial emboli or vascular death. The secondary endpoint was the incidence of hemorrhagic complications. The 157 participants (average age 74 years; 52% women; 42% with paroxysmal atrial fibrillation) were followed for an average of 0.84 years. Three nonfatal thromboembolic events were observed (1 in the anticoagulation group, 2 in the combination group) and 6 patients died (3 in the anticoagulation group, 3 in the combination group), none of them from a thromboembolic complication. However, 3 deaths were secondary to severe hemorrhagic complications (1 in the anticoagulation group, 2 in the combination group). Nonfatal hemorrhagic complications occurred more often in the combination group (n = 10, 13.1%) compared to the anticoagulation group (n = 1, 1.2%) (p = 0.003). The combination of aspirin with anticoagulant is associated with increased bleeding in elderly atrial fibrillation patients. The effect on thromboembolism and the overall balance of benefit to risk could not be accurately assessed in this study due to the limited number of ischemic events.
Talks by Philippe Raynaud
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Papers by Philippe Raynaud
Talks by Philippe Raynaud