Adolescents obèses : évaluation de l’image du corps,de l’estime de soi,de l’anxiété et de la dépression

Background

Adolescence is identified as a critical period for obesity and its complications.

Objective

To evaluate body image, self-esteem, anxiety and depression in obese adolescents.

Methods

Hundred and six obese adolescents benefited from an exploration of body image (Body Prominence, BPQ; Figure Rating Scale, FRS; Questionnaire of Body Preoccupation, QPC), self-esteem (Self-Esteem Scale, SES), anxiety (Revised children Manifest Anxiety Scale, RCMA-S), depression (Center for Epidemiologic studies–Depression Scale, CES-D).

Results

Globally, body image is disturbed. The BPQ shows a level of body consciousness greater in girls. Concerning the choice of the perceived figure, boys position themselves more frequently than girls in plump figures. For wished figures, girls choose more slim figures. However, there is no sex difference concerning body dissatisfaction that is relatively important for both sexes. The QPC indicates that girls have higher body preoccupation level than boys with specific focus on certain body area according to sex. The SES indicates that one out of two adolescents shows a low self-esteem and according to the RCMA-S, one out of three shows a high anxiety level without sex difference. Moreover, from the CES-D, one out of five adolescents, more frequently girls, exhibits a moderate to severe depression.

Conclusion

These results, with a differential interpretation (statistical vs clinical), partly confirm the data from the literature, and underline the need to perform a comprehensive investigation of body image, self-esteem, anxiety and depression in obese adolescents. In order to optimize the quality of the management provided to these youths, we proposed to physicians a pragmatic guide as “the somato-psychic pyramid”. It is important to remind that while escaping from the rule of the body fat regulation, obese adolescents may demonstrate a transgression and an adaptative marginalization.     

Changement de nom,changement de paternité et de sexualité

The replacement of “patronymic” by “name”, in January 2005, is the result of a long process, which since the late 19th century, has gradually abolished the privileges reserved for the paternal function. It is interesting to note that, during this process, the most important laws that confirmed the division of parental responsibilities between spouses of a couple were enacted in the 1970s, at a time when, following the generalization of the contraceptive pill, other laws both granted young teens free access to condoms, and young women permission to voluntarily interrupt pregnancy. Equality of man and woman in marriage as well as the separation of procreation and sexuality were thus jointly ratified, allowing the question to arise: is there a link between change in paternity and change of sex? A comparison of patri- and matrilineal kinship systems studied by anthropologists tend to show that procreation and sexuality are indeed separated when the representative of the law of the filiation group (role of the maternal uncle) and the representative of the law of exchanges (role of the father) are different. This change of law was no stranger to a change in pedagogy, which from the beginning of the 1980s gave birth to support groups open to parents in educational associations. Integrating children into society was no longer just a question of relying on the group but also on networks of exchange.     

Symptomatologie dépressive à l’adolescence : rôle de la personnalité et de la conscience émotionnelle

Aim of the study

The aim of the study was to analyze the relating contribution of personality dimensions referring to Cloninger's model and emotional awareness to depressive symptoms intensity, in a community sample of adolescents. Our purpose was also to investigate the mediating role of the emotional awareness on the personality-depression relationship.

Method

A sample of 372 school students completed the following questionnaires: the Tridimensional Personality Questionnaire (TPQ), the Level of Emotional Awareness Scale (LEAS), and the Center for Epidemiologic Studies Depression Scale (CES-D).

Results

Correlationnal and multiple hierarchical regressions analysis confirmed the existence of direct links between each personality dimensions and depression, and the partial mediating effect of emotional awareness, but only for the novelty seeking and the harm avoidance dimensions.

Conclusion

Our results confirm the relationships observed in previous research between emotion awareness and depression on one hand, and between personality and depression on the other hand. They highlight the major role played by personality and emotional processing in the vulnerability to present depressive symptoms. The importance of taking in account and assess the emotional processing in the adolescent's depression clinical support is discussed.     

Déficience sensorielle,utilisation de l’espace et constitution de l’espace psychique. Psychothérapie d’un enfant aveugle

Based on material from psychotherapy with sensory deficient patients (blind or deaf children and adults) this paper analyses subjects’ use of physical space in transference as well as in the elaboration of psychical spaces. Through the psychotherapy of Tom, a blind child, drawing upon Winnicott's work, we will show how this space, which is at first unapproachable, is progressively assimilated into a shared reality. This space is first experienced as suffering, before being ultimately used creatively and playfully as transitional space. This transformation occurs through the integration of aggressiveness induced by the occupation of this space. Any discontinuity is experienced by the patient as a rupture of the relationship. Furthermore, discontinuity is associated with the elaboration of separations and an increase in the patient's capacity to distinguish the self from the object. We thus hypothesize that differentiation from the object may pose a particular challenge for sensory deficient patients. The absence of the visual or vocal bond accentuates adhesive identifications (Bick, 1986 [6]). These pathological identifications can be repeated in transference, where they take the form of the patient's excessive need for continuous vocal tactile or visual contact. Supported by the therapist, these adhesive identifications can be overcome, and the patient's access to a three-dimensional world can be facilitated.     

Évaluer les difficultés interactives entre une mère déprimée et son bébé de 3 mois au moyen de l’échelle GRMII de Fiori-Cowley et Murray

Background and aim

Early detection of postnatal depression and mother–infant interactive difficulties are major issues not only for the emotional and cognitive development of the infant, but also for the implementation of early prevention of interactive disorders. This study examined the characteristics of mother–infant interactions in a free play situation, when infants were 3 months old, in case of maternal postnatal depression, and in a control group. The quality of interactions was assessed using the Global Ratings of Mother–Infant Interactions by Fiori–Cowley and Murray (GRMII).

Methods

The sample was composed of 90 mothers with their infants, including 39 mothers with postnatal depression and 51 without mood disorders. Affective disorder was assessed by the Montgomery and Asberg Depression Rating Scale (MADRS). Mothers and their 3-month-old infants were invited to play freely, in a room dedicated to parent–infant observation in the laboratory. Free play sequences were video recorded and a posteriori coded by two trained clinicians blind to maternal affective status, with the GRMII.

Results and conclusion

Analyses show that for all items of the GRMII, non-depressed mothers and their infant obtained higher scores i.e. better scores than depressed mothers and their infant. However, significance was evidenced only for 8 items of the grid: 3 on the maternal sensitivity scale, 2 on signs of depression, and 3 on the interactive dimension. Results thus show that at 3 months postpartum, depression appeared to have already affected interaction with the infant. Main differences were observed in mother's active engagement, acceptation, sensitivity and ability to provide adjusted responses to her infant. Analysis of maternal intrusiveness and remoteness did not yield significant findings, but conversely maternal sensitivity was negatively impacted. The GRMII appeared as an easy-to-use and objective tool to detect specificities of early depressed mother–infant interactions, adapted to a clinical setting. Early detection of interactive distortion gives a window of opportunity for a clinical intervention focused not only on maternal depressive symptoms, but also on the dyad itself.     

Activités à médiation : de l’occupationnel au thérapeutique

This reports deals with reflections by the medical staff of the Child and Teenager Care Centre about the therapeutic interest of mediator-supervised activities. This Care Centre, which is set within the university department of Child and Adolescent Psychiatry of Brest Hospital, receives mainly difficult teenagers. This study is in line with a redevelopment, at constant means, of our care offer because of the gradual changes observed in the issues and requests we have to cope with. This clinical evolution marked by deep societal motions has imposed us to modify our analysis of psychic suffering expression. The difficult teenager shows us to which extent our therapeutic and institutional tools may sometimes prove to be inadequate: indeed, his/her difficult behaviour means that we have failed. This finding drove us led us to take an interest in mediator-supervised activities that we needed to rediscover prior to appropriating them. As they proved to be better suited to difficult teenagers than “classical” approaches, we will try to highlight the ins and outs while underlining how an efficient therapy can emerge from a thorough organisation of occupations. The experience we have acquired through sailing activities will be used as illustration of our reflection.     

Représentations sociales du déni de grossesse chez des professionnels et futurs professionnels de maternité de la métropole lilloise

Objectives

Despite its longevity, the phenomenon of pregnancy denial remains without satisfactory explanation, and easily lends itself to building social imaginary. The aim of our study was to investigate on a population of professionals of maternity, the social representations of the denial of pregnancy and their relationship to professional practice.

Methods

A questionnaire was distributed by email to a population of professionals of maternity.

Results

Two hundred and forty professionals and future professionals replied to the questionnaire. Data showed differences in the representation of the denial of pregnancy, the central role of clinical experience towards the medical approach of the case and a discrepancy between the official statement and the subjective perception of this phenomenon. The participants of the study massively agreed to a systematic intervention of adult and child psychiatry for the mother-child dyad.

Conclusion

The results point the disparity of the representations of the pregnancy denial, the significance of the emotional content associated with this phenomenon and the need to develop training on the denial of pregnancy.     

Traumatisme de l’enfance et risque de démence dans le grand âge

This is the text of a conference that has attempted to show the importance of childhood in the construction of the being and the deleterious role that life's events or traumatic situations can play during this period. It was well known in psychopathology that childhood trauma can generate during adult life different psychiatric disorders. It is here to present arguments for linking the risk of developing dementia in old age and the occurrence of childhood trauma. Alzheimer's disease, a neurodegenerative dementia is questioned as to its definition and because of its diverse etiopathogenic mechanisms. We now speak of unsuccessful aging and the psychopathologic track in relation to stress takes again an important relevance. Psychotraumatisms occurring in the infantile period would have a deleterious effect on the establishment of the HPA axis that would eventually deregulated and not allowing to cope with subsequent stress that will cause every time excess cortisol which is aggressive on neurons, particularly hippocampal ones. This exaggerated biological reactivity is combined with a fragility of the adaptive mechanisms of personality, which was also built in part during childhood. This does not question a genetic underlying vulnerability, but it underscores the importance to give in the pathogenesis of Alzheimer's disease and related syndromes to psychopathological risk factors such as personality, biography and habits of life that result. Data on the dimensions of personality that make vulnerable to develop dementia are exposed and recommendations for screening strategy are proposed.     

La thérapie d’échange et de développement,une rééducation neurofonctionnelle de la communication sociale

Exchange and development therapy (EDT) is based on a neurofunctional and developmental conception of autism. It aims to rehabilitate, through structured sequences of “social play”, functions subtended by the brain systems of social communication: attention to others, intention, imitation, etc. The neurophysiological basic principles developed involved are “physiological curiosity” and “free acquisition”. Serenity conditions, availability and reciprocity facilitate mutual adjustments between the child and the adult and synchronizations. This rehabilitation therapy is carried out in the context of play and exchange adapted to all the areas of the profile of development of the child. Changes induced by EDT (behaviour, development and functioning) are measured at follow-up by standardized behavioural and psychological assessments. For example, a study of 35 children with autism followed for 9 months shows improvement in the capacity of exchange and communication in children with a severe autism associated with a developmental delay. This rehabilitation therapy is particularly indicated in young children before 4 years, period of maximum brain plasticity. The EDT is one of the major elements of the therapeutic and educational project global multidisciplinary built for the child in close relationship with the family.     

Les effets de la Loi de février 2005 vus par les équipes des secteurs sanitaire et médicosocial

Answers to the questionnaire dispatched to the staffs of sanitary and medicosocial institutions indicate how they feel the effects of February 2005's law on their practice. On the whole, feeling is rather unfavorable. Many staffs consider that new procedures disturbed their work. Their school's relationships were hindered. Meanwhile, some of them could maintain connection's quality they had before. Opinion about referent-teachers is strongly positive. Reserve came from staffs that can’t place them as a third person in their work with school. In spite of difficulties encountered, staffs made the best possible use of the instructions of the law and improved their relationships with the school and MDPH with a voluntary approach.     

Les effets thérapeutiques des groupes de parole auprès d’enfants victimes de catastrophes naturelles en Haïti

Introduction

This article focuses on groupal traumatic experiences of children during natural disasters in Haiti. The group played a very important role for psychic survival of these children and even allowed them to dream a future. The objective of this study is to identify the functions of the group that helped a therapeutic effect for children.

Method

The study focused on a sample of 217 children and adolescents aged 6–18 years, encountered in schools and churches in different cities who were severely affected by the earthquake of 12 January 2010. In focus groups set up, the children were invited to discuss their families and events in their lives.

Results

The research results show that the work of the group mobilizes groups within each participant by providing a space where the container can put into words. The group offers a bracing and a space where the process of subjectivation and symbolization can be put in place.

Discussion

We have shown how the group welcomes trauma, how intersubjective links that are established mobilize intrapsychic scene and how the game is installed, allows figurability conflict and paves the way to a narrative. It is therefore important to maintain these discussion groups essential to allow subjects to enroll in continuity and historicity needed to pick up the thread of their stories.     

Intérêts de la psychothérapie à médiation sensorielle dans le cadre de la prise en charge des troubles de la relation et de la communication chez des enfants autistes sévèrement déficitaires I : introduction aux applications cliniques

Background

Sensory and emotional disorders are typical in autism spectrum and were analyzed by psychological, neuropsychological and psychodynamic models of interpretation.

Objectives

In the current article, we aim: to analyze the theoretical models relating to the explanation of the autistic syndrome, with a particular focus on the place of its sensory features; to conceptualize an approach of psychotherapy with sensory mediation intended to formulate therapeutic proposals for remediation of relationship and communication disorders.

Method

We develop the framework of such an approach by combining the theoretical and practical foundations of: sensory integration therapies and Snoezelen approach for the matter of sensory and embodiment development (neuropsychological perspective); basal stimulation and psychomotor therapies for the stabilization of the corporeal image and body image; touch therapy and relaxation in relation to the “skin–ego” construction; and music therapy for the relational and communicative skills development. The following article will present a clinical illustration of this theoretical study. We will demonstrate our care devices and their application within the framework of a research program, and results obtained with five patients exposed during 18 months to individual and weekly sessions of psychotherapy with sensory mediation.     

Témoignages de mères usagères de substances psychoactives

Objectives

From a survey on the future of the mothers having been seen by the team of coordination and intervention with the drug users (ECIMUD) of Mulhouse between 2004 and 2006, testimonies were collected by chance.

Method

The study was realized in 2009 on 37 women for the retrospective part on medical files, then on 18 of these women having agreed to participate and to answer a questionnaire evaluating their social and medical future, which was the qualitative part of the study. These 18 women were met during interviews, which often deviated to the narrative of their courses of life.

Results

They so wished to testify of their successful fight, very often thanks to their child(ren). They also showed themselves in search of gratitude of a good mother status. Finally, they reported the necessity for the professionals to behave with them in an empathic way and to offer them a propping up that they appreciate all the more that they are socially disadvantaged.

Discussion

These testimonies underline the need of specific and adapted care for every dyad continuing several years after the childbirth, in order to improve the future of these mothers and their children.     

Réflexions à propos des effets de sollicitation interactive induits par le corps de l’enfant

The authors propose some reflections about the child's body and its associated subjective experiences, based on the idea that the body is a critical element of the interaction process and acts as a trigger and attractor of interactions. Theoretical analyses and observations of young normal children during exchanges with their mother, and also of children with a clinical condition (child hyperactivity disorder or infantile autism), have shown that an infant's body movement concentrates the mother's attention and actions, while jointly acting as an identity base for the child by way of the self-representation process rooted in bodily actions and interactions and their coenesthesia. It appears that the self-representation of a child cannot be separated from his/her actions with another person and representations of that person, and as such, it is indissociable from the affective relationship.