French-English Discussion Group on Patients with Neurological Problems

The preparatory group for 2009 met on 5 December 2008 at the Leopold Bellan Hospital, Paris.

The case of a patient with Parkinson's from the neurological ward with severe behavioural troubles such that the nursing staff had problems coping was discussed by two nurses (Mrs. Nathalie Apostoli and Mrs. Elisabeth Barrault) and a group of neurologists and psychoanalysts (Dr Annaïk Feve, neurologist and psychoanalyst; Dr. Isabelle Laffont, psychiatrist and psychoanalyst; and Dr. Diana Ribeireau, neurologist and psychiatrist). The case was reviewed medically (change of dopaminergic and antidepressant treatment); psychoanalytically (infantilization, rejection and abandonment-induced attitude, lack of verbalization); and from a behavioural perspective (communication problems with this patient were evoked, and particularly speech difficulties and play strategies). The patient's adhesiveness to his own speech, a symptom in Parkinson's known as dysexecutive syndrome, and his constant requests for physical attention led the caregiver(s) to choose to use an authoritative approach, saying, for example, “Please stop shouting! You must not shout like that,” or, “I will close the door if you persist.” A more playful approach was also discussed; for example, observing the patient