Download Document - Recherche dans serval
Transcript
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upervision interprofessionnelle Partenaires internes Case Manager (référent) PATIENT Partenaires externes " # $ L 0)D 5 5 8 0 % $ # R* Champ de la psychiatrie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• " % 7 2 8 %% 7 -" G7 - " 2 " % "" 8 • % . # " " % • $ % # NS7 -" 2 . $ : *7 % 8 ) -" 3A47 B BS8 $8 "" 08 7 0 )8, 7 :7Q > <7. : 7 * "$ 07 3ACCS48 ) $ # " " %% # 8 , $% % 6 " F % 8 % W % 2 % 8 $8 ) % 08 • % S 7 NA 3 " %% M # M " < # % % • "8 " " # -$ # " "8 48 0 - " % " +7 ' %%" 8+ 8 3 $ % 9 % 7 %% " & " # " - " *7 ?7 7 "" " # ' #M 6 # @ # # SS BA8 & 7 7 7 8 " 87 < <7 ' % *7 % 7 0 " +7 W )7 ' " = " $ 5 8 3ACC/48 , $% #$% " X 7 " # " " 7 " " " # % " 8 ' " # " # 5 G " 7 % % < ACC 48 # " 3' X @ ' 4&* NS8 L# % 7 A 7 /BS /C 8 , " - %# # 7 L# 3AC/A'& - $ &* ( %" % " #$% 7 % " % 1 $ % 9 D • %%" " % " " " %" 8 • % " 8) #$% 7 N 7 C /S8 R L 85 0 M # M "8 L # 0 • 5 DDD 8, 7 # " " % < 8+ 7 + : 85 7 )# "" % + 8+ 83ACC 48 , $% ) # " #$% %" " R 8 ( " 7 A 7 B C B C8 )8W 8 3 48 " # " M " : 7 /B3AB47 ASBN ASC 8 :8 8 < $ 3 48 %# " ) " $ A % #$% • 8 : * 0* 7 Q = *8 $ , $% • 0 = *7R 3ACCB48 L 85 R - " " % " % $ # %# AS/8 A " - W 8. 8 " % #$% # $7 ' # "6 ' - • ' 83ACCN48 # 7 / 7 CN = * 83ACC/48 0 @ % * # Y " ) MM 083 ' M # 8 @ # W % : 83ACCN48 7 /S7 S SN8 % % 8 L -" 8 "" " 8 + 7 7 # -" $ 8 CNC8 M % 8R 87 L : 8 8D7 ' "" 07 $ '7 @ # 48 * %# D $ # • # /S7 //N / S8 " " * " 8 AB3 47 " 8 < 0: 7 AC7 A /N A /C8 • • 83ACCC48 * < Y "" %" B 7 AAB AAC8 J#$% % $ /3/47 / S //N8 % 8: 0 " 7 A Caractéristiques des participants. Groupe hypnose Groupe contrôle ( N = 16) (N = 16) Total (N = 32) Genre (%) Masculin Féminin 6 (37.5) 10 (62,5) 11 (68,8) 5 ( 31,3) 17 ( 53,1) 15 ( 46,9) Age moyen 26.4 (3.3) 29.4 (5,9) 27.9 (5,0) Opiacés 14 (87,5) 13 (81,3) 27 (84,4) Cocaïne 11 (68,8) 11 (68,8) 22 (68,8) 11 (68,8) 23 (71,9) 9(56,3) 8 (50,0) Produit cons. Sédatifs/hypnotiques, Anxyolitiques. Cannabis 12 (75,0) 17 (53,1) AN L -" Changements des symptomes de sevrage après la première séance d’hypnose ou d’entretien de soutien. _____________________________________________________________________________ Evaluation Evaluation P.Value avant séance après séance Hypnose (N = 16 ) SOWS 8.3 (4,7-11,8) 4.3 (1,7-6,9) < .05 VAS Syndrôme de sevrage 2.1 (1,1-3,0) 0.5 (0,1-0,9) <.05 Envie du produit 2.4 (1,3-3,6) 1.5 (0,2-2-8) <.05 Anxiété 2.9 (1,8-4,1) 1.8 (0,5-3,1) <.05 Nervosité 3.1 (1,8-4,4) 1.5 (0,3-2,7) <.05 Mode dépressif 2.6 (1,4-3,8) 2.1 (0,6-3,5) >.05 7.9 (4,9-10,9) 5.6 (3,3-7,9 <.05 Entretiens de soutien (N = 16) SOWS VAS Syndrôme de sevrage 2.2 (1,2-3,2) 1.8 ((0,7-2.8) >.05 Envie du produit 2.4 (1,2-3,7) 2.1 (1,0-3,2) >.05 Anxiété 3.5 (2,4-4,6) 2.3 (1,5-3,1) <.05 Nervosité 3.4 (2,2-4,6) 2.2 (1,2-3,3) >.05 Mode dépressif 2.6 (1,3-3,8) 2.7 (1,4-3,9) >.05 AS L -" Changements des symptomes de sevrage après la seconde séance d’hypnose ou d’entretien de soutien. _____________________________________________________________________________ Evaluation Evaluation P.Value avant séance après séance Hypnose (N = 16 ) SOWS 10.8 (4,7-11,8) 4.1 (1,4-6,9) < .05 VAS Syndrôme de sevrage 3.3 (1,8-4,9) 2.0 (0.0-4,0) <.05 Envie du produit 2.3 (0,6-4,1) 0.8 (0,0-1,9) <.05 Anxiété 2.9 (1,1-4,8) 1.0 (0,0-2,6) <.05 Nervosité 3.3 (1,4-5,3) 1.2 (0,0-2,7) <.05 Mode dépressif 2.0 (0,3-3,7) 1.2 (0,0-2,8) <.05 8.6 (2,9-14,2) 7.7 (1,6-13,99) >.05 Entretiens de soutien (N = 16) SOWS VAS Syndrôme de sevrage 1.8 (0,1-3,4) 1.3 ((0,0-2.7) >.05 Envie du produit 0.4 (0,0-1,5) 0.5 (0,0-1,3) >.05 Anxiété 3.0 (0,9-5,0) 1.0 (0,1-1,8) <.05 Nervosité 2,6 (0,4-4,8) 1.7 (0,0-3,4) >.05 Mode dépressif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` %" < " # %% T 7" 3 7 " # ) 7 %" # ; % " % 2 1 7 8 " " !7 2 % 2 " % "" 7 47 " 7 " " " " 7 2 # # % 2 > % a -" 888 7 % %" 7 7 2 ACS 7 " # : %# D " " > 2 % ; # # " 7 % % % 2 7 % " %" " % # % & " 2 2 7 " E : 8 & * "" & > & % % % $ # ( % $ " 2 "- % F " " 2 "" %" 8 # % " " " " " "* 2 "3 % 7" $ " % % %" 2 8 4 "" % " 7 " " 4 " 9" %" 7 7 - % " > 8 " E 3E4 % E 7 2 2 + % 1 * %% # 2 7. " % 9" "7 % 2 $ " 9" E E " 7( " 2 b c W 1 8 " % " 3 7 " % " "" 2 " 2 "" 7" F " % %" 2 ( % 8 " % ' " $ "# - 8X " : %% " 0 " % " !8 J " " : " " 1 % % 7 " " # " % > -" % #9% " & $% " " " " " " X $ % 2 $ 2 7 X " " " % 7 " X " 2 "7 % %" 2 % $ # 3 % 2 #$% #1 47 %# 1 7 " " 7& 2 8: % 7 8 & 9 72 7# 7% % > " d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a 2 7 2 %" " # % " 7 "" 2 "" " "" 2 7 % 1 2 "2 B 8 % %" 1 % # 7 -" 8 "" 1 " 2 % % -" % $ # % 2 1 > " /S7 2 % " 7 & # % % " % 7 % 8 *% 1 % 7 " %" 7 7 "" " 2 % 2 % 2 " "2 % %" 8, % "% 8 2 8 # %" :8 8 * Q "# # % " % $ # 1 2 H F 7 F " 1 " # > : 8 % %" % " & " % & 7 # " % 7 " 2 " 7 2 1" # %% E > " 2 7) I" 8 %" 7' " " "7 ) $ # " " " 2 8 2 72 "" " % $ # 1 7 " % "" " % $ # a "" 2 7 "" 7 " %" 7 8 # 2 "2 " " D" % T 2 " % % 7% " 7 % 7 # % $ # % " "" 7 # ! " " % $ # " & % % & % " 2 % 7 % % " % "" > " 8) 2 8 " 8 " 2 % > 3 2 "" 7 T 7 " 2 7 7 "" " " % 2 8 " 48 7 8 % " "- -" % # % 2 " # 8 "" &" 88 % "% - " 8 % $ # &" % % F % " 2 "^ # % %" "" % F 7 1" 7 -" "& " % 2 7 " 8 8 "" 8 " " % $ # " % -" " #2 % F % 47 7 % " " 8 " % F " 72 " -" 8 -" % % 7 # > 7% % & -" & -" F 3 " " % " " 72 F " " " % 2 % ""1 % % " & 7> 7% % " %% 2 % -" 2 " ) T F # 6 2 " / 7 "" " % 7% F X 7 6 " % AA # 2 7 7 = 6" " $ 7" 4 " > 2 6 7% " "" 83 $ " 7% "" % - "7 " 7 % 2 " F " > 2 7 " " "" 7 2 8 D" > # 8 8 eeeeeeeeeeeeeeeeeeeeeeeeeeeee < 7. - % 6R = 7) $ 7 "" 7 W "" 7 AC/ 8 " - J 0 2 % !8 - : 9 % 8 " 2 7 F #2 % !C8 % 2 " F 6R 7 % 1 7 - . " 7 F D" + %" %# 7 )" 9 2 % # 2 %# " F " L " % % * + , . : 5 ? ; - # 5 7D 1 '% " ) < " 7D ' ( )* * 8 0 = >7 D + ( )* 8 + 7D '% " " 2 "" " "" % % $ # 2 "2 2 ' ( )* * 8 + ( )* 8 80 "^ # " " & " %" " 2 - % " % 8 2 1 " + 1 % ! " " " "1 $7 " " a % % 7 " 2 " " ! % " K 1 " %% " " 7 # + "" 2 2 % . " ! " : , 1 8 9 !7 ) 4 " N " % % " $ "" 8 7 - 7" " ! & $ 7 " " " % * $ 10 " $ * 3 9 7" " -" -" # % & 7 %" 9 2 " = " %" # %" 2 !% 8 " 1 -" %" " 6 " 7 # - 7 & % % 1 2 #9% % " 8 0F %% " " ACN 7 % %"9 % * " % 2 " 7" " "& # 7 % 8 % 2 % $ # " [ % $ # %" 9 8 7 ! AA % " " " " " " %% % & F 7 %" " 8 + "^ a " ^ " 2 # 1 A " % " ! 6 > % % % ""1 % % "2 # " 7% % %" ! "8 D 7 & " % 11 7 ACS 7 " % % /A7 f I %"9 % " % /S7 f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a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• " ' % " § ACC " % % 2 % # 6 7" - %" % " % % % 1 " % > % "" ' " " > 7 " : & " " § * ' 2 8 " " ; ! % /8 2 ! % % % # % ) " D 7 8 ' " * > "" > % % 1 2 $ %" " " ) " " " 7 % % " % % " % " D % 7 % # % , Q " - " % ) " " $ ) " A ` 7 " " § # §. " " " §* §. • " D)5 L Q " % • W + - 4 % -" # % " " 3 2 * ! " /#J /7 " AB8 S & A # " 8 S & A #8 X $ & % " "7 " " ; 8 D" " " " % 8 ! % % 7 % % > • " • " "7 - • + 2 /7 " % $ #2 % " " %#1 > % -" • ( > 7 " ' D+ * 3 2 7 # # 7 % > 7 8 3 47 " - " 7 > > > 7 8 # "" $7 # 2 > 8 ' " " " % 48 • + % 66" " % * 6 +1 " 48 " • ( -" 75 " % 84 "" 1 " 8 2 % W # • ( % " 2 " " "8 & / 4 3 & % % • 0 3 " " • D " 3 2 % " %" % " " " % " " % • % %" 2 % 8 30 N 4 7 % - 4 • % # - " 2 4 ) % - " 30 * 7 2 % " 1 • % # ( 5 "* • * - " "" + ( )* J+ ) , ( Q • $ 3 % ' D+ * W • • -1 " " Q "" ! # ! 6 ! 3 - "" 4 ! 3 " % 1 " A # & 6 #48 A " % /#J / "* • -" " " ) • % % " % % " ! * 1 " % " "8 X % 1 " " • • 5 # % Q % %" > 1 "" " 8 > 3AB "1 2 6 7 " 8 2 - ) % % "" %" 3" 2 " " % > ) &" % 1 " % $ # • • • " " # " " # " ! $ ; - % % % % " # % " + %" " % H " X a E4 ' & " "" - • * % %" % " " % -" & " / % ""1 5 %% " % D D < ! 8 • % "" # 3H • 2 " "" " ! " % $ #2 D " 7 8 % % " % " # 6 %# # " " % D " J- ! " $ & ) " 7 " " W " " " # % % " * % " " + "" 4 "8 " " % 6 8 ^ " $ " " % -" 2 % "" !% # % 1 2 " ' 8 "" "2 %" & • " $ # 4 • Q % " % $ #2 # • " % % • " % % - "" % % " " " 8 % 2 % %% 1" " . % # -"1 -" & " " 8 % # " -> 7 %%" -" " 5 % & " $ " 1 " " & > "" 7 " % " " % % " 7 1 " 2 & 2 " " 2 - # % % % %" " - % % " # " > % # 8 % -" ) 7 %" 9 ) " % 8 % % %" " % % " & " " d " " " " 2 6 % % & > % > % $ #2 ""1 % # " " " % "1 2 2 " % # 7 % -" 1 " & - % -" % " 8 # ) " "" 7 -" 7 & " % $ #2 " %" & % 8 -" % # % > " % -" % # 7& " " %" # " " 2 " -" 1 8 2 %" % " 7 " "" 8 D" - -" - # -" " " % 7 %" % % % -" 2 & " " % % 7" % - # - ; - % & & % % 8 * 2 % % 1 F # # 6 " 8 " 7" 2 % 1 " $% " 8 7" " % " 2 % # % % "" % - 7" 2 " 7 2 % % 8 % & 7 " %" % % % -"1 2 " F % %" 9 % " % # 8 + 1 " 7" "" " % -" " % "" % ) " 8 % " % 2 " " " -" 2 % > "" % % " 8 " % " 8 5 % > 8 " 7 # # " " > " % % - # % & % " 8 " " # " _______________________________ / Hospices cantonaux Département de Psychiatrie / CHUV ETAT DE VAUD " # / Directeur des Soins Jean-Michel Kaision # $ & )* % !!+ $ , , ---. . , , # # $0 . 1 2 3 $4. % %&' ( .