Background: Empathy in primary care settings has been linked to improved health outcomes. However... more Background: Empathy in primary care settings has been linked to improved health outcomes. However, the operationalisation of empathy differs between studies, and no study concurrently compared affective, cognitive, and behavioural components of empathy regarding patient outcomes. Moreover, it is unclear how gender interacts with the studied dimensions. Aim: To examine the relationship between several empathy dimensions and patient-reported satisfaction, consultation’s quality and trust in physician, and to determine whether this relationship is moderated by physician’s gender. Design and setting: Analysis of 61 primary care physicians’ empathy in relation to 244 patient experience questionnaires in French-speaking part of Switzerland. Method: Sixty-one physicians were videotaped with two male and two female patients. Six different empathy measures were assessed: two self-reported measures, a facial recognition test, two external observational measures, and a Synchrony of Vocal Mean ...
OBJECTIVE The present study explores students' perspective on the added value of a virtual pa... more OBJECTIVE The present study explores students' perspective on the added value of a virtual patient (VP) simulation as part of a breaking bad news training in undergraduate medical education. METHODS The VP simulation allows trying out and practicing different ways of disclosing a cancer diagnosis to a VP (avatar) and to react to emotionally-laden patient statements with the opportunity of self-observation through video recording. After testing the simulation, 23 students shared their experience in focus groups analyzed using thematic analysis. RESULTS Self-observation is the most valued feature of the simulation, because it enables users to reflect on their behaviors and adjust them. The competences developed are otherwise technical (e.g., organization of information) and concern less interactional competences. Areas for improvement of the simulation are the interactivity, quality, and diversity of the VPs. CONCLUSION The findings show that VP simulations help develop technical communication competences and are best suited as add-ons to other forms of training, in which relational aspects can be targeted. Self-observation is especially valued because it allows for a critical view regarding one's own communication behaviors in a stress-free environment. PRACTICE IMPLICATIONS The proposed simulation is beneficial as an add-on to lectures, supervision, and simulated patient interviews.
Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are both e... more Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are both effective treatments for some patients with obsessive-compulsive disorder (OCD), yet little is known about the neurochemical changes related to these treatment modalities. Here, we used positron emission tomography and the α-[C]methyl-L-tryptophan tracer to examine the changes in brain regional serotonin synthesis capacity in OCD patients following treatment with CBT or SSRI treatment. Sixteen medication-free OCD patients were randomly assigned to 12 weeks of either CBT or sertraline treatment. Pre-to-post treatment changes in the α-[C]methyl-L-tryptophan brain trapping constant, K* (ml/g/min), were assessed as a function of symptom response, and correlations with symptom improvement were examined. Responders/partial responders to treatment did not show significant changes in relative regional tracer uptake; rather, in responders/partial responders, 12 weeks of treatment led to serotonin ...
In addition to providing psychiatric care to patients with somatic diseases, liaison psychiatry p... more In addition to providing psychiatric care to patients with somatic diseases, liaison psychiatry plays an important role in the teaching of the relational aspects of the clinical encounter between patients and clinicians. This series of three articles proposes a critical reflection on this topic, and presents examples of undergraduate and postgraduate teaching programs developed by the psychiatric liaison service at Lausanne University Hospital. This article describes the general context of undergraduate teaching, and focuses on our training with simulated patient of a breaking bad news situation, taking place during the fourth year of medical studies. Individual supervision, provided for each student, is discussed as a relatively unique opportunity within the curriculum of medical school.
Journal of cancer education : the official journal of the American Association for Cancer Education, Jan 22, 2017
This article reports on what is at work during individual supervision of medical students in the ... more This article reports on what is at work during individual supervision of medical students in the context of teaching breaking bad news (BBN). Surprisingly, there is a relative lack of research and report on the topic of supervision, even though it is regularly used in medical training. Building on our research and teaching experience on BBN at the undergraduate level, as well as interviews of supervisors, the following key elements have been identified: learning objectives (e.g., raising student awareness of structural elements of the interview, emotion (patients and students) handling), pedagogical approach (being centered on student's needs and supportive to promote already existing competences), essentials (e.g., discussing skills and examples from the clinical practice), and enhancing reflexivity while discussing specific issues (e.g., confusion between the needs of the patient and those of the student). Individual supervision has been identified as crucial and most satisfac...
Introduction: Delirium is a highly prevalent disorder, with serious con sequences for the hospit... more Introduction: Delirium is a highly prevalent disorder, with serious con sequences for the hospitalised patient. Nevertheless, it remains under diagnosed and undertreated. We developed evidencebased clinical practice guidelines (CPGs) focusing on prevention, screening, diagnosis, and treat ment of delirium in a general hospital. This article presents the implementa tion process of these CPGs and a beforeafter study assessing their impact on healthcare professionals’ knowledge and on clinical practice. Methods: CPGs on delirium were first implemented in two wards (Neu rology and Neurosurgery) of the Lausanne university hospital. Interactive onehour educational sessions for small groups of nurses and physicians were organised. Participants received a summary of the guidelines and completed a multiple choice questionnaire, assessing putative changes in knowledge, before and three months after the educational session. Other indicators such as “diagnosis of delirium” reported in the discharge letters, and mean duration of patients’ hospital stay before and after implementa tion were compared. Results: Eighty percent of the nurses and physicians from the Neurol ogy and Neurosurgery wards attended the educational sessions. Both nurses and physicians significantly improved their knowledge after the implemen tation (+9 percentagepoints). Other indicators were not modified by the intervention. Conclusion: A single interactive intervention improved both nurses’ and physicians’ knowledge on delirium. Sustained and repeated interventions are probably needed to demonstrate changes in clinical practice.
Training medical students in breaking bad news (BBN) in oncology may be key to improve patient ca... more Training medical students in breaking bad news (BBN) in oncology may be key to improve patient care in an area where many physicians tend to be uncomfortable. Given the lack of evidence in the literature, this study aimed to assess empirically the impact of 2 teaching strategies to prepare students for the task of BBN in oncology: one-to-one simulated patient (SP) training with individual feedback (intervention group) vs small-group SP training with collective feedback (comparison group). Fourth-year students (N = 236) were randomly assigned to the intervention or comparison group. The SP videotaped interviews were analyzed with respect to BBN communication performance, rated using the Calgary-Cambridge checklist of teaching objectives for BBN; verbal interaction behaviors, coded with the Roter interaction analysis system; and 7 nonverbal behaviors. Students in the intervention group scored significantly higher after than before the training on the overall evaluation of the interview (P < .001) as well as on process skills (P < .001); they also obtained significantly higher scores compared to students in the comparison group on the overall evaluation of the interview (P < .001) and on process skills (P < .001). This study supports an individualized BBN teaching strategy and contributes to efforts to find the best way to train and reach the largest number of future physicians to improve communication competences in oncology.
OBJECTIVE: To describe the functioning and clinical results of the first multi-disciplinary neuro... more OBJECTIVE: To describe the functioning and clinical results of the first multi-disciplinary neuro-HIV platform for HIV-infected patients in Switzerland. BACKGROUND: Despite the availability of combination antiretroviral therapy (cART), neurological complications, in particular the cognitive ones, remain a challenge in HIV-infected patients. Frequently, co-morbidities are intermingled with HIV, rendering the diagnostic and therapeutic procedures difficult in these patients. DESIGN/METHODS: In March 2011, we set up, at the Lausanne University Hospital, a multi-disciplinary Neuro-HIV Platform composed of infectiologists, neurologists, neuropsychologists, psychiatrists, and neuroradiologists. During a day-hospitalization, the patient benefits from a clinical evaluation by all these specialists, together with blood work-up, brain MRI and lumbar puncture. At the end of the day, diagnosis and treatment plan are discussed by the whole team. RESULTS: From March 2011 to September 2013, we evaluated 75 consecutive patients (49 men, 49.8±9.3 y, nadir CD4+ T cells 170.8±143.8 cells/mm 3 , current CD4 + 569.9±258 cells/mm 3 , 75% with undetectable plasma HIV RNA, 90% with undetectable CSF viral load, 99% on cART, revised CPE score 7.6±1.6). Main referral cause was cognitive complaints (89%), which were confirmed in 78% of those. The leading causes of cognitive disorders were psychiatric conditions (44% of all the confirmed) and HIV-associated neurocognitive disorders (HAND) (29%). Neurological deficits were evidenced in 47% of the total cohort (central signs in 20%; peripheral signs in 27%). Brain MRI was abnormal in 52%, mostly due to slight to moderate cortical/subcortical atrophy. The presence of HAND was correlated with a lower nadir CD4+ T cells (p=0.007). No other correlation was found between HIV disease status and neurological deficits. CONCLUSIONS: Neurological/neuropsychological complications are frequent in well-treated HIV+ patients, consisting mainly in cognitive disorders. The latter are more often ascribed to a psychiatric condition than to HIV infection itself. A multi-disciplinary approach is a real asset to take care of these complex patients. Study Supported by: We are indebted to AbbVie, Gilead, Bristo-Myers Squibb who made this Neuro-HIV platform possible. Disclosure: Dr. Du Pasquier has received personal compensation for activities with Biogen Idec, Novartis, Abbott, ViiV, Merck Serono, and Merck Sharp & Dohme Ltd. Dr. Simioni has nothing to disclose. Dr. Alves has nothing to disclose. Dr. Meuli has nothing to disclose. Dr. Maccaferri has nothing to disclose. Dr. Berney has nothing to disclose. Dr. Cavassini has received research support from Merck Sharp & Dohme Ltd., and Gilead.
Dissociative disorders often have an atypical neurological presentation requiring a complex diagn... more Dissociative disorders often have an atypical neurological presentation requiring a complex diagnostic process at the interface between neurology and psychiatry. A strong interdisciplinary collaboration is needed for diagnosis restitution and patient treatment. Current knowledge is still scarce but recent studies in clinical neuroscience enrich this field. This article presents the main aspects of dissociative disorders and suggests a treatment framework.
It has been suggested that hysteria had waned and was an old-fashioned, stigmatizing and false co... more It has been suggested that hysteria had waned and was an old-fashioned, stigmatizing and false concept, reflecting the incapacity of the medical community to establish a diagnosis in certain situations. Nowadays, however, those disturbances, now referred to as conversion or dissociative disorders, still remain a frequent and incapacitating condition that every clinician faces. These past decades, several studies have tried to better describe their clinical presentation and their neurobiological mechanisms, with the help of the development of new neuroimaging techniques. If the neurobiological correlates are now better understood, efficient treatments are still lacking and only a multidisciplinary (general practitioners, neurologists and psychiatrists) and individually-tailored therapy might be beneficial to the patients.
Les troubles cognitifs se rencontrent souvent en medecine de premier recours, en particulier chez... more Les troubles cognitifs se rencontrent souvent en medecine de premier recours, en particulier chez les personnes âgees. Le depistage de ces troubles est recommande pour identifier les personnes qui pourraient beneficier d'une prise en charge. En cas de depistage positif ou d'une plainte mnesique, une investigation approfondie des axes somatiques, cognitifs, psychopathologiques, fonctionnels et des repercussions sur les proches doit etre envisagee. Des examens de laboratoire et une neuro-imagerie sont en general indiques. Cette investigation multiaxiale peut etre confiee a des consultations-memoire. Elle permettra en general de distinguer le vieillissement normal, le mild cognitive impairment, d'identifier les differentes etiologies organiques et fonctionnelles des syndromes dementiels et des etats confusionnels.
Cognitive deficits are frequently encountered in primary care settings, in particular in the elde... more Cognitive deficits are frequently encountered in primary care settings, in particular in the elderly. Screening of these deficits is recommended and aims at identifying subjects who are likely to benefit from treatment. In the event of either positive screening or cognitive complaint, further somatic, cognitive, psychopathological, and functional assessment should be performed and possible consequences on family caregivers sought. Laboratory tests and neuro-imaging are often necessary. This multi-dimensional assessment may require the expertise of a memory clinic to distinguish normal aging, mild cognitive impairment, and to identify the different organic and functional aetiologies of the dementia syndrome and delirium.
Les troubles dissociatifs se presentent souvent par une clinique neurologique atypique impliquant... more Les troubles dissociatifs se presentent souvent par une clinique neurologique atypique impliquant une demarche diagnostique complexe a l'interface de la neurologie et de la psychiatrie. La restitution du diagnostic aux patients et leur prise en charge necessitent une etroite collaboration interdisciplinaire. Les connaissances actuelles sont encore limitees, mais ce domaine est enrichi par des etudes recentes en neurosciences cliniques. Cet article presente les principaux aspects des troubles dissociatifs et formule un concept de prise en charge.
Background: Empathy in primary care settings has been linked to improved health outcomes. However... more Background: Empathy in primary care settings has been linked to improved health outcomes. However, the operationalisation of empathy differs between studies, and no study concurrently compared affective, cognitive, and behavioural components of empathy regarding patient outcomes. Moreover, it is unclear how gender interacts with the studied dimensions. Aim: To examine the relationship between several empathy dimensions and patient-reported satisfaction, consultation’s quality and trust in physician, and to determine whether this relationship is moderated by physician’s gender. Design and setting: Analysis of 61 primary care physicians’ empathy in relation to 244 patient experience questionnaires in French-speaking part of Switzerland. Method: Sixty-one physicians were videotaped with two male and two female patients. Six different empathy measures were assessed: two self-reported measures, a facial recognition test, two external observational measures, and a Synchrony of Vocal Mean ...
OBJECTIVE The present study explores students' perspective on the added value of a virtual pa... more OBJECTIVE The present study explores students' perspective on the added value of a virtual patient (VP) simulation as part of a breaking bad news training in undergraduate medical education. METHODS The VP simulation allows trying out and practicing different ways of disclosing a cancer diagnosis to a VP (avatar) and to react to emotionally-laden patient statements with the opportunity of self-observation through video recording. After testing the simulation, 23 students shared their experience in focus groups analyzed using thematic analysis. RESULTS Self-observation is the most valued feature of the simulation, because it enables users to reflect on their behaviors and adjust them. The competences developed are otherwise technical (e.g., organization of information) and concern less interactional competences. Areas for improvement of the simulation are the interactivity, quality, and diversity of the VPs. CONCLUSION The findings show that VP simulations help develop technical communication competences and are best suited as add-ons to other forms of training, in which relational aspects can be targeted. Self-observation is especially valued because it allows for a critical view regarding one's own communication behaviors in a stress-free environment. PRACTICE IMPLICATIONS The proposed simulation is beneficial as an add-on to lectures, supervision, and simulated patient interviews.
Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are both e... more Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are both effective treatments for some patients with obsessive-compulsive disorder (OCD), yet little is known about the neurochemical changes related to these treatment modalities. Here, we used positron emission tomography and the α-[C]methyl-L-tryptophan tracer to examine the changes in brain regional serotonin synthesis capacity in OCD patients following treatment with CBT or SSRI treatment. Sixteen medication-free OCD patients were randomly assigned to 12 weeks of either CBT or sertraline treatment. Pre-to-post treatment changes in the α-[C]methyl-L-tryptophan brain trapping constant, K* (ml/g/min), were assessed as a function of symptom response, and correlations with symptom improvement were examined. Responders/partial responders to treatment did not show significant changes in relative regional tracer uptake; rather, in responders/partial responders, 12 weeks of treatment led to serotonin ...
In addition to providing psychiatric care to patients with somatic diseases, liaison psychiatry p... more In addition to providing psychiatric care to patients with somatic diseases, liaison psychiatry plays an important role in the teaching of the relational aspects of the clinical encounter between patients and clinicians. This series of three articles proposes a critical reflection on this topic, and presents examples of undergraduate and postgraduate teaching programs developed by the psychiatric liaison service at Lausanne University Hospital. This article describes the general context of undergraduate teaching, and focuses on our training with simulated patient of a breaking bad news situation, taking place during the fourth year of medical studies. Individual supervision, provided for each student, is discussed as a relatively unique opportunity within the curriculum of medical school.
Journal of cancer education : the official journal of the American Association for Cancer Education, Jan 22, 2017
This article reports on what is at work during individual supervision of medical students in the ... more This article reports on what is at work during individual supervision of medical students in the context of teaching breaking bad news (BBN). Surprisingly, there is a relative lack of research and report on the topic of supervision, even though it is regularly used in medical training. Building on our research and teaching experience on BBN at the undergraduate level, as well as interviews of supervisors, the following key elements have been identified: learning objectives (e.g., raising student awareness of structural elements of the interview, emotion (patients and students) handling), pedagogical approach (being centered on student's needs and supportive to promote already existing competences), essentials (e.g., discussing skills and examples from the clinical practice), and enhancing reflexivity while discussing specific issues (e.g., confusion between the needs of the patient and those of the student). Individual supervision has been identified as crucial and most satisfac...
Introduction: Delirium is a highly prevalent disorder, with serious con sequences for the hospit... more Introduction: Delirium is a highly prevalent disorder, with serious con sequences for the hospitalised patient. Nevertheless, it remains under diagnosed and undertreated. We developed evidencebased clinical practice guidelines (CPGs) focusing on prevention, screening, diagnosis, and treat ment of delirium in a general hospital. This article presents the implementa tion process of these CPGs and a beforeafter study assessing their impact on healthcare professionals’ knowledge and on clinical practice. Methods: CPGs on delirium were first implemented in two wards (Neu rology and Neurosurgery) of the Lausanne university hospital. Interactive onehour educational sessions for small groups of nurses and physicians were organised. Participants received a summary of the guidelines and completed a multiple choice questionnaire, assessing putative changes in knowledge, before and three months after the educational session. Other indicators such as “diagnosis of delirium” reported in the discharge letters, and mean duration of patients’ hospital stay before and after implementa tion were compared. Results: Eighty percent of the nurses and physicians from the Neurol ogy and Neurosurgery wards attended the educational sessions. Both nurses and physicians significantly improved their knowledge after the implemen tation (+9 percentagepoints). Other indicators were not modified by the intervention. Conclusion: A single interactive intervention improved both nurses’ and physicians’ knowledge on delirium. Sustained and repeated interventions are probably needed to demonstrate changes in clinical practice.
Training medical students in breaking bad news (BBN) in oncology may be key to improve patient ca... more Training medical students in breaking bad news (BBN) in oncology may be key to improve patient care in an area where many physicians tend to be uncomfortable. Given the lack of evidence in the literature, this study aimed to assess empirically the impact of 2 teaching strategies to prepare students for the task of BBN in oncology: one-to-one simulated patient (SP) training with individual feedback (intervention group) vs small-group SP training with collective feedback (comparison group). Fourth-year students (N = 236) were randomly assigned to the intervention or comparison group. The SP videotaped interviews were analyzed with respect to BBN communication performance, rated using the Calgary-Cambridge checklist of teaching objectives for BBN; verbal interaction behaviors, coded with the Roter interaction analysis system; and 7 nonverbal behaviors. Students in the intervention group scored significantly higher after than before the training on the overall evaluation of the interview (P < .001) as well as on process skills (P < .001); they also obtained significantly higher scores compared to students in the comparison group on the overall evaluation of the interview (P < .001) and on process skills (P < .001). This study supports an individualized BBN teaching strategy and contributes to efforts to find the best way to train and reach the largest number of future physicians to improve communication competences in oncology.
OBJECTIVE: To describe the functioning and clinical results of the first multi-disciplinary neuro... more OBJECTIVE: To describe the functioning and clinical results of the first multi-disciplinary neuro-HIV platform for HIV-infected patients in Switzerland. BACKGROUND: Despite the availability of combination antiretroviral therapy (cART), neurological complications, in particular the cognitive ones, remain a challenge in HIV-infected patients. Frequently, co-morbidities are intermingled with HIV, rendering the diagnostic and therapeutic procedures difficult in these patients. DESIGN/METHODS: In March 2011, we set up, at the Lausanne University Hospital, a multi-disciplinary Neuro-HIV Platform composed of infectiologists, neurologists, neuropsychologists, psychiatrists, and neuroradiologists. During a day-hospitalization, the patient benefits from a clinical evaluation by all these specialists, together with blood work-up, brain MRI and lumbar puncture. At the end of the day, diagnosis and treatment plan are discussed by the whole team. RESULTS: From March 2011 to September 2013, we evaluated 75 consecutive patients (49 men, 49.8±9.3 y, nadir CD4+ T cells 170.8±143.8 cells/mm 3 , current CD4 + 569.9±258 cells/mm 3 , 75% with undetectable plasma HIV RNA, 90% with undetectable CSF viral load, 99% on cART, revised CPE score 7.6±1.6). Main referral cause was cognitive complaints (89%), which were confirmed in 78% of those. The leading causes of cognitive disorders were psychiatric conditions (44% of all the confirmed) and HIV-associated neurocognitive disorders (HAND) (29%). Neurological deficits were evidenced in 47% of the total cohort (central signs in 20%; peripheral signs in 27%). Brain MRI was abnormal in 52%, mostly due to slight to moderate cortical/subcortical atrophy. The presence of HAND was correlated with a lower nadir CD4+ T cells (p=0.007). No other correlation was found between HIV disease status and neurological deficits. CONCLUSIONS: Neurological/neuropsychological complications are frequent in well-treated HIV+ patients, consisting mainly in cognitive disorders. The latter are more often ascribed to a psychiatric condition than to HIV infection itself. A multi-disciplinary approach is a real asset to take care of these complex patients. Study Supported by: We are indebted to AbbVie, Gilead, Bristo-Myers Squibb who made this Neuro-HIV platform possible. Disclosure: Dr. Du Pasquier has received personal compensation for activities with Biogen Idec, Novartis, Abbott, ViiV, Merck Serono, and Merck Sharp & Dohme Ltd. Dr. Simioni has nothing to disclose. Dr. Alves has nothing to disclose. Dr. Meuli has nothing to disclose. Dr. Maccaferri has nothing to disclose. Dr. Berney has nothing to disclose. Dr. Cavassini has received research support from Merck Sharp & Dohme Ltd., and Gilead.
Dissociative disorders often have an atypical neurological presentation requiring a complex diagn... more Dissociative disorders often have an atypical neurological presentation requiring a complex diagnostic process at the interface between neurology and psychiatry. A strong interdisciplinary collaboration is needed for diagnosis restitution and patient treatment. Current knowledge is still scarce but recent studies in clinical neuroscience enrich this field. This article presents the main aspects of dissociative disorders and suggests a treatment framework.
It has been suggested that hysteria had waned and was an old-fashioned, stigmatizing and false co... more It has been suggested that hysteria had waned and was an old-fashioned, stigmatizing and false concept, reflecting the incapacity of the medical community to establish a diagnosis in certain situations. Nowadays, however, those disturbances, now referred to as conversion or dissociative disorders, still remain a frequent and incapacitating condition that every clinician faces. These past decades, several studies have tried to better describe their clinical presentation and their neurobiological mechanisms, with the help of the development of new neuroimaging techniques. If the neurobiological correlates are now better understood, efficient treatments are still lacking and only a multidisciplinary (general practitioners, neurologists and psychiatrists) and individually-tailored therapy might be beneficial to the patients.
Les troubles cognitifs se rencontrent souvent en medecine de premier recours, en particulier chez... more Les troubles cognitifs se rencontrent souvent en medecine de premier recours, en particulier chez les personnes âgees. Le depistage de ces troubles est recommande pour identifier les personnes qui pourraient beneficier d'une prise en charge. En cas de depistage positif ou d'une plainte mnesique, une investigation approfondie des axes somatiques, cognitifs, psychopathologiques, fonctionnels et des repercussions sur les proches doit etre envisagee. Des examens de laboratoire et une neuro-imagerie sont en general indiques. Cette investigation multiaxiale peut etre confiee a des consultations-memoire. Elle permettra en general de distinguer le vieillissement normal, le mild cognitive impairment, d'identifier les differentes etiologies organiques et fonctionnelles des syndromes dementiels et des etats confusionnels.
Cognitive deficits are frequently encountered in primary care settings, in particular in the elde... more Cognitive deficits are frequently encountered in primary care settings, in particular in the elderly. Screening of these deficits is recommended and aims at identifying subjects who are likely to benefit from treatment. In the event of either positive screening or cognitive complaint, further somatic, cognitive, psychopathological, and functional assessment should be performed and possible consequences on family caregivers sought. Laboratory tests and neuro-imaging are often necessary. This multi-dimensional assessment may require the expertise of a memory clinic to distinguish normal aging, mild cognitive impairment, and to identify the different organic and functional aetiologies of the dementia syndrome and delirium.
Les troubles dissociatifs se presentent souvent par une clinique neurologique atypique impliquant... more Les troubles dissociatifs se presentent souvent par une clinique neurologique atypique impliquant une demarche diagnostique complexe a l'interface de la neurologie et de la psychiatrie. La restitution du diagnostic aux patients et leur prise en charge necessitent une etroite collaboration interdisciplinaire. Les connaissances actuelles sont encore limitees, mais ce domaine est enrichi par des etudes recentes en neurosciences cliniques. Cet article presente les principaux aspects des troubles dissociatifs et formule un concept de prise en charge.
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