Recherche d’association entre abus de cannabis et bipolarité : étude sur un échantillon de patients hospitalisés pour un trouble bipolaire

Introduction

Cannabis use is very frequent in bipolar disorder and has been found to increase the duration and frequency of manic symptoms while decreasing those of depression. Bipolar patients who use cannabis were shown to have poorer compliance to treatment, more symptoms that are psychotic and a worse prognosis than patients who do not. In this study, we have evaluated the importance of cannabis use among bipolar patients admitted to the Psychiatric Hospital of the Cross, Lebanon (Hôpital Psychiatrique de la Croix [HPC]) as well as the clinical differences between cannabis users and non-users.

Approche psychométrique de la métacognition : étude pilote en population clinique

Background

Metacognition describes the process of thinking about one's own thought processes. This concept was introduced by Flavell in 1979 and has since been widely developed in the cognitive approach to mood and anxiety disorders. As it happens, many recent studies have underlined the links between metacognition and anxio-depressive symptoms, pointing out the interest of assessing its various dimensions. The short form of the Metacognitions Questionnaire is a brief multidimensional measure of a range of metacognitive processes and metacognitive beliefs about worry and cognition relevant to the vulnerability to and the maintenance of emotional disorders. The aim of this study was twofold: firstly to adapt and validate a French version of the short form of the Metacognitions Questionnaire (MCQ-30) and to assess its psychometric properties in a clinical sample, and secondly to investigate metacognitive predictors of anxiety and depression in this sample.

Création et validation d’une échelle de qualité de vie et d’une grille d’observation des caractéristiques personnelles et environnementales pour les enfants polyhandicapés : enseignements d’une étude

Measuring the quality of life of people with profound intellectual and multiples disabilities (PIMD) is a major issue for the affected persons themselves, for their families and for the professionals working near them, but raises serious methodological issues for researchers. A study was lead in 2011 by a team of researchers from Comité d’études, d’éducation et de soins auprès des personnes polyhandicapées (CESAP – Comity for studies, education and care for people with PIMD), in order to build a quality of life scale for children with PIMD from 6 to 14 years old. In this paper, we present its theoretical as well as methodological learnings: the scale could not be statistically verified, but we gathered very rich data about personal and environmental features of children with PIMD nowadays in France. Moreover, this study opens up interesting perspectives to imagine other ways to investigate those children's quality of life.     

Les comorbidités psychiatriques dans le transsexualisme : étude sur une population de transgenres libanais

IntroductionThe question of whether gender dysphoria is associated with psychiatric comorbidity has been addressed in several studies. Several cohort studies have shown that psychiatric comorbidity is one of the main features of poor prognosis following sex change therapy. Gender dysphoria is rare, with an estimated prevalence of 0.001% to 0.002% globally. The literature shows a high prevalence of psychiatric comorbidities in people with gender dysphoria, and that they are more common in male to female transsexuals. Data on long-term mortality show that transsexuals present a 51 % increase in mortality compared to the general population. This is mainly attributed to a six-fold increase in the number of suicides and a higher rate of psychiatric disorders and risky behaviors leading to HIV infection and substance abuse.PurposeAssess psychiatric comorbidity in a population of Lebanese transgender individuals and compare it to the general population. The hypothesis of our study is that the Lebanese transgenders suffer from more psychiatric comorbidities than the general population. Our second objective was to determine the specific mental health needs of this population in order to adapt our services to their medical needs and their specific concerns.MethodsOur objective was to acquire 20 transgender participants and 20 control subjects. We chose a snowball sampling method. The evaluation consisted of three questionnaires including a general demographic questionnaire, the MINI 5.0.0 Arabic version for axis I disorders and the SCID-II for axis II disorders.ResultsThe mean age of both groups was 23.55 years. Fifty-five percent (n = 11) transgender participants had active suicidal thoughts against 0 % in controls. Within the group of transgender, 45 % (n = 9) had a major depressive episode, 5 % (n = 1) had a generalized anxiety disorder, 5 % (n = 1) had a posttraumatic stress disorder and 10 % (n = 2) had a major depressive episode with comorbid posttraumatic stress disorder. We noted a significant difference between the two groups regarding the presence of suicidal ideation (P = 0.000) and the presence of axis I disorders (P = 0.039).DiscussionIn our study, we noted demographic and economic characteristics specific to the population of transgender individuals. We found a significant difference in the level of education, economic status and household composition. Transgender individuals suffer from more psychiatric pathologies compared to the general population. This may be due to social and familial discrimination and ostracism. These results demonstrate the vulnerability of this population. An awareness program for mental health professionals is essential in order to adapt care to the specific needs of this population. A list of non “transphobic” mental health professionals should be established.     

Proposition d’une méthode d’évaluation de l’entretien psychodynamique : analyse approfondie d’une étude de cas en oncologie

ObjectivesThe aim of this study is to evaluate the effects of the psychodynamic approach in the context of psychoanalytical psychotherapy in clinical interviews conducted by the clinical psychologist.MethodologyIt involves analyzing the narrative productions of the interaction patient–psychologist to determine mental processes in a single-case design protocol. This approach integrates the three dimensions qualitative, quantitative and statistical of research. We will test the clinical study with a intensive case or a deeply analyzed single case.EthicsOur approach answers to the inquiry of evaluation in Public Health, according to the psychoanalytical epistemology into methodology, principle and practice of objectification, intersubjectivity and singularity. By combining research and clinical interviews we would like to respond to be the closest of the patient's experience and his work of mental development.ResultsThis work should help to argue the interest of proposals for supportive or psychodynamic psychotherapy in psychiatry as well as medical departments. Being at the heart of the clinic, we focus on the changing processes at work in psychological development work without ever reaching a standardized clinic which would replace the theoretical-clinical orientation of the practitioners.     

Identification de marqueurs sociaux et émotionnels associés à l’hallucination acoustico-verbale (HAV) en population pédiatrique : étude Physalis

ObjectivesAuditory-verbal hallucinatory experiences (AVH) represent a prevalence of 12% in the general pediatric population. They are most often considered as a transient and benign developmental phenomenon, associated with mood and anxiety disorders. The persistence of AVHs for several years and into adolescence would represent a poor prognosis of progression into a psychiatric disorder, and more particularly psychotic disorder. The alteration of social and emotional cognitive markers are described as prodromal of this unfavorable progression which should be considered within the continuum between subclinical and clinical signs of the “psychosis phenotype”. The objective of this study was to assess these markers in children and adolescents with AVH and their correlation with the presence and persistence of hallucinations.MethodsMulticenter prospective case-control study, longitudinal over 6 months. Patients were included based on the presence of HAV on clinical examination. Forty subjects aged 8 to 16 years from a clinical pediatric population were included. They were divided into two groups according to the Diagnostic Interview Schedule for Children-Child version (DISC-C): a group with AVH (“AVH+”), and a group without HAV (“AVH?”). A diagnosis of schizophrenia spectrum disorder was a non-inclusion criterion according to the criteria of DSM-5 (K-SADS-PL). This group was matched to the control group without AVH (AVH?) according to sex, age (± 6 months) and associated psychiatric diagnoses assessed by the MINI-Kid. The marker of social cognition was assessed with the NEPSY II test. The emotional marker was assessed with the self-questionnaires: EED IV, which highlights the emotions currently being felt by the subject, and the BAVQ-R, which categorizes the child's emotions in reaction to AVH.ResultsNo significant link was found between the social and emotional cognition markers and the presence of AVH at T0. At 6 months, 50% of subjects in the AVH+ group suffered from persistent AVH and 18% progressed to a diagnosis of schizophrenia spectrum disorder. The persistence of AVH was not significantly correlated with the marker of social cognition, but it was significantly correlated with the presence of negative emotions (sadness, fear, hostility and anger) and inversely correlated with emotions of joy.ConclusionIn this study, AVH experiences in the pediatric population are not linked to markers of social cognition, but negative emotions appear as early markers of AVH persistence.ClinicalTrials.gov IdentifierNCT02567500.     

Le vécu familial des enfants atteints du cancer : une étude qualitative de la perception par les enfants de la dynamique familiale

The research focuses on the family experience of children suffering from cancer. Despite considerable improvements these recent years and whatever are the prognostic and diagnostic, childhood cancers remains an ordeal that challenges all children's landmarks and previously established family balance. In the need of facing to the traumatic event, status and role of each family member are reorganized. Previous studies have focused mainly on parental stress and adaptation. Despite that developmental theories and family approaches regard children as active parts of their family system with unique representations, surprisingly the child's point of view received very little attention. Consistent with family system theories and ecological developmental Bronfenbrenner's framework, this study examines specifically to how children with cancer perceive their family system and its changes since the announcement of the disease. Five 7- to 9.5-year-old boys participated in this study. All are hospitalized in a long-time pediatric onco-hematology service. Three research tools aimed to assess the family dynamic (1) the Systemic Analysis of Group Affiliation (SAGA) – a test tridimensional test largely used in systemic therapy in line with Minuchin's theory. It is a floating object with a circular checkerboard, fifteen 10-cm wood non-commercial figurines representing diverse family members including two sick children as well as yellow or blue token, which allow assessing the power and influences of each member along the child's perception. Children are invited to choose as much as figurines they want to depict their family, to place them on the checkerboard according to their proximity and give to each figurine none to several token in function of their influence within the family circle. Two indices are calculated: cohesion and hierarchy. (2) Family drawing along with Corman's procedure combined with the modern attachment assessing approach (3) a semi-directed interview. Data analyses are quantitative as well as qualitative in line with the triangulation guideline. Findings indicate that the three information sources are complementary, but the SAGA is a playful and sensitive tool that captures more accurately the child's perception of changes within the family circle. Results of SAGA show that children perceive moves in both cohesion and hierarchy since the announcement of the disease. Concerning cohesion, children perceive an increased closeness with their mother and grandparents, a decreased one with siblings and a stable but low one with father. Concerning hierarchy, they perceive a reversal of roles with an increase of their own power and a decrease for both parents and siblings. Family drawings enlighten a diversity of attachment patterns consistent with personal emotional history of each child. But they are not sensitive to moves related to the disease. Interviews have been useful to confirm all already collected information but do not provide any crucial new one. Discussion considered the importance to take into account the children's point of view on their family dynamic and the impact of their disease on family members in the care management. Such approach will allow sensitive empowerment care practices and reinstate to children their child status and confirm them as real actors within the family circle. Discussion ponders over the interest and accurateness of the three assessing tools.     

Éveil visuel à l’image chez de jeunes enfants cérébrolésés : étude pilote d’un accompagnement pluridisciplinaire pour une intégration multimodale

To arouse the visual interest for image, the essential support for the prerequired school learnings, we proposed a work on shadows to five brain-damaged children presenting an important delay of psychomotor development and cerebral visual impairment. In a first part, the visual perceptions are stimulated by colors and elementary geometrical forms then by simple shadow figures thrown onto a screen. In a second part, the spatial and temporal structuralizations, the proprioception and the body image are worked by creating shadows with the body on the screen. We observed different types of visual and behavioral improvements: increase of the interest for image both by its creation and by its observation, increase of visual attention, more obvious social relationships. This therapeutic and educational experiment conducted over one year testifies of the importance of a multi-field coverage both by pooling the knowledge and by confronting objectives of the therapists and educator team for a holistic support of the young brain-damaged child in the understanding of image processing.     

Processus psychologiques de gestion du stress et régulation neuroendocrinienne chez les adolescents délinquants en institution fermée : une étude pilote

Background

Adolescence is a stressful period where important biological, psychological and social changes occur. Adolescents are particularly vulnerable during this developmental period and can use various strategies to deal with daily stress, such as substance use or externalizing behaviors. In previous studies, stress in adolescents with externalizing behaviors was often linked to ineffective cognitive coping strategies (i.e., constructive thinking) and overlooking the biological aspects involved in stress management such as neuroendocrine regulation. Indeed, repeated activation of the hypothalamic-pituitary-adrenal (HPA) axis in chronic stress situations may have long-term effects on subsequent cortisol regulation and lead to psychological difficulties. It was also shown that basal cortisol levels are lower in adolescents with externalizing behaviors. This study aims to assess the links between constructive thinking and neuroendocrine regulation in adolescent offenders and their association with externalizing symptoms (e.g., aggression, delinquency, psychopathic traits, substance use). Identifying particular biopsychological patterns can help to better understand stress management in youth with externalizing behaviors and to improve clinical treatments.

Prévalence des troubles psychiatriques et addictologiques auprès de trois générations successives de migrants : résultats d’une étude menée en population générale

Introduction

Mental health of migrant populations has become a major public health issue since these populations more often suffer from mental health problems than host populations. The influence of the migration process on the emergence of these disorders and its impact on future generations is uncertain. This study provides an estimate of the prevalence of mental disorders among three generations of migration.

Caractérisation d’une population de patients hospitalisés sous contrainte en ASPDT/u et ASPPI à partir d’un service d’urgence psychiatrique parisien

BackgroundThe French mental health law, first enacted on July 5, 2011, introduced the possibility of psychiatric commitment in case of extreme urgency (imminent peril – ASPPI). The decision of involuntary admission can then be made by the hospital director based on a medical certificate, without the need of a third party request. This procedure was intended to be applied on an exceptional basis, but its use is steadily increasing against the other types of involuntary care. Our study aimed at comparing the characteristics of patients who had received an indication for involuntary admission due to imminent peril (ASPPI) or at the request of a third party (ASPDT/u) in a psychiatric emergency ward, according to sociodemographic and clinical characteristics and regarding the potential implication of a third party.MethodsAn observational study was conducted among patients from the Centre Psychiatrique d’Orientation et d’Accueil (CPOA), located at Sainte-Anne hospital in Paris, from August 1st to 31st, 2016.ResultsOne hundred and fifty patients with an indication for involuntary commitment were included, 101 of whom for ASPDT/u (67 %) and 49 for ASPPI (33 %). For more than half of the patients from the ASPPI group, a third party had been identified with (39 %) or without (17 %) contact information. Compared to ASPDT/u patients, ASPPI individuals were more socially vulnerable, showed more negligence, and had a lower mean functioning score. The indication for ASPPI status was also associated with behavioural quirks, prior psychiatric hospitalization (especially as an ASPPI patient) and with the diagnosis of chronic psychosis instead of mood disorder.ConclusionOur exploratory results help to better understand how the ASPPI procedure is used in psychiatric emergency wards six years after enactment of the law. They highlight the differences between ASPPI patients and ASPDT/u and raise ethical issues regarding involuntary psychiatric care.