["Syndrome de glissement": clinical description, psychopathological models, and care management].

"Syndrome de glissement", a French geriatric concept, is a serious state of physical and psychological destabilization, including anorexia, malnutrition, withdrawal and opposition. It can be compared to the American "failure to thrive syndrome" although it is a somewhat different and less extensive conception. It occurs after a free period following a disease being cured or a moving event. Considering that it has no known medical etiology and that it presents psychological symptoms, several theories can be considered. It differs from melancholia in several points: clinically, depressive thoughts are not as clear as in melancholia; biologically, there is no history of bipolar disorder and there is a poor response to antidepressants; according to a psychoanalytical model, there no longer appears to be any mental work, unlike in melancholia. Psychopathological mechanisms could be close to essential depression, involving disunion of instincts, and progressive disorganization, with a psychosomatic disorganization following a traumatism. The comparison with anaclitic depression of babies, also proposed for the American failure to thrive syndrome, leads us to question the link between "syndrome de glissement" and early traumatisms such as maternal deprivation. Moreover, it enhances the importance of environment and lack of anaclisis for the onset of a "syndrome de glissement" and its evolution. Relationship between the patient and his/her caretakers is frail and extremely necessary. When the syndrome occurs, relatives and caretakers are submitted to violent feelings, which can give rise to excessive reactions. This is the reason why a third party is required in order to support the caregiver-caregiven couple, which can be the institution. It is the only way caretakers can be supportive enough for the patient. Copyright (c) 2009 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.