The concept of therapeutic community in a psycho-geriatric day hospital: a case report

Early-onset alzheimer's disease is characterized by massive deficits of higher cortical functions occurring in the course of socially active life. During the post-diagnosis time period, the rapid evolution of this disorder induces severe psychological repercussions which affect both patients and their families. In this context, the development of community care programs in psychiatry for these patients may provide an appropriate support to avoid hospitalizations. Benefits of a two days psychotherapeutic community program in a psycho-geriatric day hospital are illustrated by the case report of a 56 year-old patient with early-onset alzheimer's disease who developed a severe depressive episode without psychotic symptoms. We describe an intense weekly psychiatric treatment performed by a multidisciplinary team during a 6 months period. Based on a holding experience containing anxiety and providing hope, it offered a space for expression of difficult emotions and thoughts such as guilt, anger and failure and allowed to improve social relationships by confronting attitudes to ageing and dementia. Working in caring networks makes possible to share common knowledge about the disease and, at the same time, allows the construction of a common therapeutic attitude directly involving the patient and informal caregivers.