La somnolence chez les adolescents: étiologie et conséquences multiples

Over the past century a dramatic decline in sleep duration among adolescents, such as more than one hour of sleep loss per night, has been reported. A debt in sleep duration could lead to sleep deprivation, a major risk factor associated with daytime sleepiness. Sleepiness refers to the inability to maintain an adequate level of alertness during the day which may result in more or less being able to control falling asleep at inappropriate times. This literature review updates on sleepiness regarding its characteristics, etiology and consequences on adolescents. Studies revealed that from 25 % to 78 % of adolescents had reported sleepiness. Its manifestations may include heavy lids, yawns, difficulties to concentrate and emotional irritability. In addition, while it is recommended that adolescents under 18 years-old should sleep from eight to ten hours a night, only 63 % of them actually do so. The etiology of sleep deprivation and sleepiness in this population can be explained by various biological and societal factors. First, the sleep-wake cycle of adolescents shows a biological shift from the beginning of pubertal maturation, described as a perfect storm. It refers to a social jetlag by going to sleep and waking up later and accumulating a sleep debt during weekdays which they try to reimburse during weekends. This phenomenon can be explained by physiological changes such as a slower accumulation of sleep pressure. In addition to this perfect storm, environmental and societal factors contribute to the social jetlag and reduce sleep duration in adolescents. Screen exposure before bedtime can delay sleep and wake onset, which is a risk factor for sleeping debt. Substance use such as caffeine, cigarettes or electronic vaporizer, ADHD or freely available medication, alcohol, cannabis use or drug consumption could further disrupt sleep-wake cycle by stimulating, depressing or otherwise disrupting the central nervous system. Early, before 8:30 am, class start times have been associated with chronic sleep deprivation, higher level of sleepiness and delayed melatonin peak secretion. Adolescents working or doing extracurricular occupations for more than 20 hours a week are more at risk for reduced sleep duration and sleepiness. Parental supervision about sleep during the weekdays were associated with more appropriate bedtime. Adolescents from low socio-demographic characteristics and from minority ethnic groups have reported displaying a shorter sleep duration. Finally, sleep disorders of a physiological origin such as narcolepsy, sleep apnea or restless legs syndrome, may explain the sleep deprivation and sleepiness. Sleep deprivation and sleepiness in adolescents have consequences on their health. Cognitive functioning, such as problem solving, attention or memory, as well as school performance, can be compromised by sleep deprivation and sleepiness. At the psychological level, adolescents reporting sleepiness are more prone to display mental health problems: associations were found between sleepiness and subjective perception of depression, anxiety, somatic complaints as well as with antisocial behaviors. Finally, 68 % of 16 year-old adolescents reported they drove a car, and the reported sleepiness could lead to road accidents due to reduced attentional functioning, reaction time and decision-making abilities. In the United-States, from 7 % to 16.5 % of deadly accidents were related to driving while drowsy. Highlighting etiology and problems associated with sleep deprivation and sleepiness in adolescents could guide researchers and clinicians towards the development of possible interventions. Public health measures and knowledge transfer programs regarding modifiable psychosocial and societal factors associated with sleep-wake bioregulation could increase awareness in parents as well as in political and societal decision makers.     

La dépression chez les proches de patients souffrant de schizophrénie : effets longitudinaux sur 8 mois du programme ProFamille

Introduction

Mental illness such as schizophrenia is a major public health concern. In France, the economic cost of schizophrenia represents 2% of total medical expenditures. Schizophrenia has an impact on health and quality of life not only for patients but also for relatives. Family psychoeducation is a complementary therapeutic intervention to ordinary clinical care deigned to alleviate the burden of care among relatives of patients with schizophrenia. Literature suggests such programs including the patients’ family members reduce the risk of relapse. Current studies also suggest that negative emotions expressed by family members have negative consequences on patients’ mental health and need to be addressed. However, family psychoeducation is still underdeveloped in France. The objective of this study was to assess the longitudinal outcome on depression level of a psychoeducation program for relatives of schizophrenic patients. The program was held in Paris and Région Île-de-France “Cluster ProFramille Île-de-France” between 2012 and 2014.

Soutien social,dépression et estime de soi chez les personnes âgées : les résultats d’une analyse en cluster

ObjectiveThis study investigated the relation in later life between social support and different mental health variables: depression and self-esteem. Social support was considered according to Cutrona and Russell's approach, which includes six dimensions: attachment, social integration, reassurance of worth, reliable alliance, guidance, and opportunity for nurturance. Several authors attributed to social support a major protective role in mental health. In fact, different links between social support and mental health variables were found in adulthood. More and more studies deal with social support in later life. In particular, the protective role of social support in stressful live events and its relation to mental health or illness have been examined. The objective of this study was to clarify the links between social support, depression and self-esteem in later life, with an alternative statistical method.MethodA cluster analysis was performed in order to group together older persons on the basis of their social support level. Ninety-three French older people living in their home were recruited, with a mean age of 70.72 (SD: 7.06). The social support was assessed with Caron’ social support scale (The Social Provision Scale) which measures the six functions of social relationships. Depression and self-esteem were evaluated respectively with the Center for Epidemiologic Studies Depression Scale (CES-D) and the Rosenberg Self-Esteem Scale. Cluster analysis was chosen because it allows to bound natural groupings within data and to determine homogeneous groups inside the sample of the study. Then, ANOVA were performed in order to compare these groups as for their depression and self-esteem scores.ResultsFirst, results revealed three social support profiles or groups: High social support level, Moderate social support level and Low social support level. Group with high social support level presents high level for all dimensions of social support: attachment, social integration, reassurance of worth, reliable alliance, guidance, and opportunity for nurturance. In addition, groups with moderate and low levels of social support are characterized respectively by moderate and low levels for all dimensions of social support. Second, different relationships of these profiles with depression and self-esteem were found. The older persons with high level of social support present a low depression level associated high self-esteem. Moreover, participants with moderate or low social support profile present high depression and low self-esteem levels.ConclusionThe relationship between social support and mental health was brought to light. The clinical implications and possible interventions are discussed. In particular, different methodological and conceptual approaches of social support interventions are evoked, such as interventions, which include family, friends or peers.     

Anticipation et dépression

Depression can be seen as an anticipation disorder. Anticipation is a psychological mecanism underlying project. The study of depressed elderly with the “anticipation test” of M. Berta accentuates the psychic polarisation and implies the hypothesis of a “container” for the anticipation functioning.     

Insomnie et dépression

The close links between insomnia and depression are complex. Insomnia is at the same time a symptom and a trigger factor of depression, under certain conditions. An interrupted sleep pattern reduces sleep time. It thus induces a stress reaction with a hyper activation of the hypothalamic- pituitary function. It is a high factor risk for depression. Anomalies of sleep patterns are predictive of a depression risk. This is also the case in families with depressed parents. The density of REM sleep appears as the most specific candidate for an endophenotype of depression.     

Facteurs associés à la cyberaddiction chez les adolescents Tunisiens

IntroductionInternet addiction, a relatively new phenomenon, is a field of recent research in mental health, particularly within young populations. It seems to interact with several individual and environmental factors.ObjectivesWe aim to spot internet addiction in a Tunisian adolescent population, and to study its relationship with personal and family factors, as well as with anxious and depressive comorbidities.MethodsWe conducted a cross-sectional study of 253 adolescents recruited in public places in the city of Sfax in the south of Tunisia. We collected biographical and personal data as well as data describing family dynamics. The internet addiction was assessed by Young's questionnaire. Depressive and anxious co-morbidities were assessed using the HADS scale. The comparative study was based on the chi-square test and the Student's test, with a significance level of 5 %.ResultsThe prevalence of internet addiction was 43.9 %. The average age of internet-addicts was 16.34 years, the male sex was the most represented (54.1 %) and increased the risk of internet addiction (OR a = 2.805). The average duration of connection among Internet addicts was 4.6 hours per day and was significantly related to internet addiction; P < 0.001). Socializing activities were found in the majority of the internet-addicted adolescents (86.5 %). The type of online activity was significantly associated with internet addiction (P = 0.03 and OR a = 3.256). Other behavioral addictions were frequently reported: 35.13% for excessive use of video games and 43.25 % for pathological purchases. These two behaviors were significantly associated with internet addiction (with respectively P = 0.001 and P = 0.002 with OR = 3.283). The internet-addicted adolescents lived with both parents in 91.9 % of cases. The mother's regular professional activity was significantly associated with internet addiction risk (P = 0.04) as was the use of the Internet by parents and siblings (with respectively P = 0.002 and P < 0.001 with OR = 3.256). The restrictive attitude of the parents was significantly associated with internet addiction risk (P < 0.001 OR = 2.57). Family dynamics, particularly at the level of adolescent-parent interactions, were a determining factor in internet addiction. Anxiety was more frequently found than depression among our cyber-dependent adolescents with frequencies of 65.8 % and 18.9 %, respectively. Anxiety was significantly correlated with the risk of internet addiction (P = 0.003, OR a = 2.15). There was no significant correlation between depression and the risk of internet addiction.ConclusionThe Tunisian adolescent seems at great risk of internet addiction. Targeted action on modifiable factors, especially those affecting family interactions, would be very useful in prevention.     

La dépression aux urgences psychiatriques : une expérience quotidienne

Depression is the most common psychiatric disorder in the general population, and emergency room visits for depression have been increasing for several years. In addition, the Covid-19 pandemic may lead to an explosion of psychiatric emergency room visits for this reason, with an overall prevalence of anxiety and depression that appears to be increasing since 2020. The Centre Psychiatrique d’Orientation et d’Accueil is a regional psychiatric emergency service located in Paris which records approximately 10,000 consultations per year. Among these consultations, the main symptoms are those of depression (depressive ideations, anxiety) and nearly 40 % are diagnosed with mood disorders, including depression. The management of the patient in the emergency room is based on a global evaluation, which should not be limited to the psychiatric interview. In the best case, and if compatible with the organization of the service, an initial evaluation by the nursing reception staff determines the context of the arrival of the patient, the reason and the degree of urgency of the consultation can thus be assessed from the outset. The request for care can come from the patient themself, but also from family and friends who are worried about a decline in the patient's previous condition. The consultation may also be triggered by the intervention of emergency services, particularly in the case of attempted suicide or agitation. The context of arrival, the environment, and the patient's entourage must be taken into account in order to achieve an optimal orientation. Particular attention must be paid to the first episodes (elimination of a differential diagnosis, screening for a possible bipolar disorder). The existence of an external causal factor or a comorbid personality disorder should not trivialize the consultation and lead to a faulty diagnosis of a characterized depressive episode. Drug treatment in the emergency room is usually symptomatic (anxiolytic treatment with benzodiazepines or neuroleptics, depending on the situation), and outpatient referral should always be preferred. Therapeutic adaptations can then be considered. The decision to hospitalize must always be justified, and consent for care must be rigorously evaluated. It is almost always necessary to take the patient's entourage into account as well as the potential support of the patient by the entourage. All these elements must be recorded in the file. Suicide risk assessment must be systematic for all patients consulting psychiatric emergencies, and the use of the RUD (Risk, Urgency, Dangerousness) grid can be useful. Any decision to release a patient with suicidal tendencies must be made strictly following certain conditions:a rapid psychiatric re-evaluation of the crisis, with for example the proposal of a post-emergency consultation, a supportive entourage, accepted symptomatic treatment. The registration of the suicidal patient in a monitoring system such as VigilanS can also be beneficial and reduce the risk of recidivism.     

Trouble stress post traumatique,dépression et anxiété chez les parents d’enfant(s) atteint(s) d’épilepsie

IntroductionPost-traumatic Stress Disorder (PTSD), depression and anxiety are the most common psychiatric consequences among parents of children with epilepsy.ObjectivesWe aimed to investigate the prevalence and predictors of PTSD, depression and anxiety in a sample of parents of children with epilepsy.MethodsA survey of 135 parents of children with epilepsy, treated in the pediatric neurology department at the Sfax Teaching Hospital in Tunisia, was conducted in the last quarter of 2019. The PTSD Checklist for DSM-5 and the Hospital Anxiety and Depression Scale (HADS) were used to assess, respectively, PTSD, depression and anxiety in parents. Associations with clinical and demographic variables with PTSD, depression and anxiety were evaluated in a logistic regression model.ResultsResults revealed PTSD rates of 20.7%, depression rates of 28.9% and anxiety rates of 55.6%. The main factors associated with PTSD on multivariable analysis were female gender (P = 0.026, ORa = 13.1), insufficient involvement of partner in disease management (P < 10^?3, ORa = 12.1) and duration of epilepsy less than 12 months (P = 0.001; ORa = 0.1). Female gender (P = 0.006, ORa = 18.1) and restriction of social life (P = 0.006, ORa = 4.1) were associated with depression. Factors associated with anxiety were insufficient involvement of partner in disease management (P = 0.03, ORa = 4.6) and PTSD (P = 0.005, ORa = 9.1).ConclusionThese findings suggest that clinicians should pay more attention to psychological health of parents of children with epilepsy and help healthcare providers to develop preventive and intervention strategies for parents of such children.     

Le harcèlement chez les adolescents victimes : méthodologie d’une recherche internationale

IntroductionBullying is a complex and global phenomenon. It is estimated that 100 to 600 million adolescents are affected worldwide. Many studies have examined bullying over the past twenty years, but French publications remain rare.ObjectivesThe objectives of this article are to clarify the definition of bullying in order to circumscribe the framework of our qualitative research, and to present the methodology of an international research currently underway.Patients and methodsOur sample consists of 40 ou 50 French, Brazilian and Turkish adolescents. These patients have the following characteristics: they are aged 12 to 18 years; they are consultants in specialized centers; they are interviewed at least three months after bullying has stopped, for ethical reasons and in order to evaluate the PTSD according to international classifications; finally, they show clinical signs related of psychological suffering to the trauma and traces of a controlling relationship. The criteria for non-inclusion are as follows: severe psychiatric disorders (active delusional pathologies), bullying still ongoing. In order to test our first hypothesis regarding the study of psychological and family vulnerabilities, we chose several tools: the non-directive research interview and the projective tests Rorschach, TAT, family drawing and house drawing. In order to test our second hypothesis regarding the consequences of bullying, namely the study of symptoms of post-traumatic stress, we chose three tools: the non-directive research interview, the TraumaQ and the SCL-90.ResultsFollowing a review of the literature and in support of our clinical practice and the initial data from this research, we discussed complementary criteria for defining bullying, in addition to those usually mentioned, in other words: repetition, intensity, frequency and the power of imbalance. Bullying, as a violent relational process, includes clinical signs of acute psychological suffering that often reveal the presence of symptoms of post-traumatic stress and traces of control mechanisms in the victim that are found in any emotional abuse. We have also focused our definition on two essential dimensions: adolescence and the group, and more particularly on taking into account adolescence as a time of narcissistic fragility and the reactivation of psychological problems, which often make it necessary to support a group of peers. This support appears all the more “vital” as these young people move away from their family group at the same time. In these circumstances, some adolescents, who are identified as having family and psychological vulnerabilities and who have difficulty positioning themselves in a group, may become “easy” prey and be subjected to violence. Without considering a typical bullied profile, the question of psychological vulnerabilities and in particular trauma, i.e. the appetite for repeated trauma and overexposure to potentially traumatic situations, is an interesting avenue.ConclusionThe complexity of bullying lies in the superposition of family and individual factors. Like any violence, it has long-term effects, and it seems essential to offer specific care that makes it possible, in addition to alleviating suffering by providing support, to carry out a thorough analysis of the psychological issues underlying the establishment of a controlling relationship and its sustainability. The secondary prevention component, which includes specific care beyond primary prevention programs in schools, therefore seems important to us to develop. At the end of this article, we will detail the care support which combines the forum theatre method and a multi-family group that we suggest to the victims of bullying.     

La dépression majeure à caractéristique atypique comme facteur de risque du syndrome d’apnées obstructives du sommeil chez le jeune adulte

ObjectivesIn the literature, several studies have investigated the particular relationship between major depression and obstructive sleep apnoea syndrome (OSAS). However, most of these studies have focused primarily on middle-aged to elderly individuals (≥ 40 years) which means that this problem has been little studied in young adults (< 30 years). Nevertheless, in young adults the prevalence of major depression (particularly its atypical subtype) is not negligible, which seems to justify carrying out additional investigations in order to allow a better understanding of the potential role played by major depression in the pathophysiology of OSAS in this particular subpopulation. The aim of this study was therefore to empirically investigate the prevalence of OSAS in young adults and to study the risk of OSAS associated with major depression in this particular subpopulation.MethodsPolysomnographic and demographic data from 264 young adults were collected from the Erasme Hospital Sleep Laboratory (Brussels, Belgium) database to enable our analyses. During their two-night stay (including a first night of habituation and a night of polysomnography) at the Sleep Laboratory, these individuals underwent a complete somatic assessment (including blood test, electrocardiogram, daytime electroencephalogram and urinalysis), a systematic psychiatric assessment by a unit psychiatrist and an assessment of their complaints related to sleep. These different steps made it possible to systematically diagnose all somatic pathologies, psychiatric disorders according to the diagnostic criteria of the DSM-IV-TR and sleep pathologies according to the diagnostic criteria of the AASM. This allowed the selection of young adults included in our study based on our inclusion and exclusion criteria. Polysomnographic recordings from our Sleep Laboratory were visually scored according to AASM criteria. An obstructive sleep apnoea-hypopnoea index ≥ 5/hour was used for the diagnosis of OSAS. At the statistical level, in order to allow our analyses, we subdivided our sample of young adults into two groups: a control group without OSAS (n = 215) and a patient group with OSAS (n = 49). After checking the normal distribution of our data, normally distributed data were analysed with t-tests whereas asymmetrically or dichotomously distributed data were analysed with Wilcoxon tests or Chi² tests. Univariate regression models were used to study the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults and potential confounding factors. In multivariate regression models, the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults was adjusted only for confounding factors significantly associated with OSAS during univariate analysis. These confounding factors were introduced in a hierarchical manner in the various multivariate regression models constructed.ResultsThe prevalence of OSAS in our population of young adults was 18.6 %. During univariate analyses, atypical depression [OR 2.51 (95% CI 1.18–5.32), p-value = 0.014], male gender [OR 4.53 (95% CI 2.20–9.34), P-value < 0.001], presence of snoring [OR 2.51 (95% CI 1.33–4.75), P-value = 0.005], presence of at least one cardio-metabolic alteration [OR 2.26 (95% CI 1.19–4.28), P-value = 0.012], body mass index> 30 kg/m² [OR 4.55 (95% CI 2.07–10.03), P-value < 0.001] and ferritin ≥ 150 μg/L [OR 3.28 (95% CI 1.69–6.36), P-value < 0.001] were associated with increased risk of OSAS in our population of young adults. After adjusting for these major confounding factors associated with OSAS (gender, body mass index, cardio-metabolic alterations, ferritin level, and snoring) in the four models studied, multivariate regression analyses confirmed that unlike typical depression, atypical depression [OR 3.09 (95% CI 1.26–7.54), P-value = 0.019] was a risk factor for OSAS in young adults.ConclusionsIn our study, we demonstrated that the prevalence of OSAS was 18.6 % in young adults referred to the Erasme Hospital Sleep Laboratory. In addition, we have shown that unlike typical depression, atypical depression was associated with an increased risk of OSAS in young adults, which seems to justify more systematic research of this pathology in young adults suffering from atypical depression in order to allow the establishment of adapted therapeutic strategies and avoid the negative consequences associated with the co-occurrence of these two pathologies.     

Nouveaux médias sociaux,nouveaux comportements de sommeil chez les adolescents

Objective

Modification of sleep behaviors in teenagers has been observed over the past 30 years with a reduction in overall sleep time and an increasing number of teenagers suffering from sleep deprivation. Sleep deprivation is linked to physical problems such as obesity but also to change in performance at school and mood disorders. Changes have been associated with the use of screens, cell phones, Internet and social media. Use of screens has been shown to delay sleep onset and melatonin secretion and stimulation of wake systems by interaction with social media may exacerbate these effects. The links between the use of social media and sleep patterns have not been fully explored. Our study aimed to evaluate the effects of social media on teenagers’ sleep and the impact of sleep deprivation.

Dépression et anxiété chez les patients atteints d’hémopathies malignes : prévalence et facteurs associés

BackgroundAnxiety and depression in cancer patients are associated with impaired well-being and overall quality of life.ObjectivesTo study the prevalence of depression and anxiety in patients with hematological cancer, and to assess the relationship between various demographic, behavioral and clinical factors and anxiety and depression among hematological cancer patients.MethodsThis cross-sectional study recruited 159 diagnosed hematological cancer patients and 182 participants without cancer (control group) in the University hospital center Ibn Rochd of Casablanca, Morocco. Study participants fulfilled the Hospital anxiety and depression scale (HADS) and demographic and cancer characteristics.ResultsThe mean age of hematological cancer patients was 43.9 years (SD = 13.8 years), while the mean age of the control group was 45.3 years (SD = 15.4 years). Using a cut-off score of 8 on HADS, anxiety and depression were found in 78.6% of hematological cancer patients against only 35.1% in control group. Logistic regression analysis revealed that anxiety and depression were associated with age under 40 years.ConclusionHematological cancer patients are in high risk to develop depression and anxiety. An age less than 40 years can be a predicting factor related with depression and anxiety in hematological cancer patients.     

Reconnaissance émotionnelle chez les enfants de 3 ans en fonction du sommeil et du risque de dépression

Introduction

The emotional process is characterized by a negative bias in depression, thus it was legitimate to establish if they same is true in very young at-risk children. Furthermore, sleep, also proposed as a marker of the depression risk, is closely linked in adults and adolescents with emotions. That is why we wanted first to better describe the characteristics of emotional recognition by 3-year-olds and their links with sleep. Secondly we observed, if found at this young age, an emotional recognition pattern indicating a vulnerability to depression.

La mesure de l’usage des réseaux sociaux chez les adolescents: une revue systématique de la littérature

ObjectiveThe purpose of this review was to provide an overview of the methods used to measure social network site use among adolescents. Such a review is important given the number and diversity of sites and the prevalence of their use among adolescents.MethodsA systematic review of the literature was conducted in line with PRISMA guidelines to arrive at an analysis of 58 peer-reviewed studies indexed in PubMed, PsychInfo, or Scopus. To be included in the review, articles had to be peer-reviewed, available in full text, and published in French or English. For inclusion, studies were required to pertain to adolescents aged between 11 and 18 years; to focus on social network site use and indicate how their use was estimated. Studies that simultaneously examined social network sites and general internet use or video games and only provided a combined analysis were excluded. The keywords for the search were: social media use, social media usage, social media misuse, measure, teen, and adolescents.ResultsIn the literature, different methods were used to operationalize the use of social network sites: quantitative methods with the measurement of frequency and duration of use of social network sites, and qualitative methods to measure the different activities adolescents engage in on such sites. In this review, 28 articles investigated the use of social media through a measurement of frequency and 22 articles through a measurement of the duration of use. Most of the studies focused on social network sites in general, without specifying which sites in particular were considered by the respondents when answering the question. However, some articles provided cross measures of quantitative and qualitative measurements resulting in the examination of both the frequency of use and the time spent on specific activities on social network sites.ConclusionsThe present review highlights the great diversity in the methods used to measure the use of social network sites among adolescents. The reliance on frequency-based measurements without taking into account the specificities of the activities or sites involved limits the investigation of their impact on adolescent functioning and behaviors. Given the observed discrepancies in the literature concerning the measurement of social network site use among adolescents and their associated biases, the development of specific instruments is needed to advance in this important field of research.     

La mémoire déclarative antérograde et ses modèles

IntroductionPatient H.M.’s recent death provides the opportunity to highlight the importance of his contribution to a better understanding of the anterograde amnesic syndrome. The thorough study of this patient over five decades largely contributed to shape the unitary model of declarative memory. This model holds that declarative memory is a single system that cannot be fractionated into subcomponents. As a system, it depends mainly on medial temporal lobes structures. The objective of this review is to present the main characteristics of different modular models that have been proposed as alternatives to the unitary model. It is also an opportunity to present different patients, who, although less famous than H.M., helped make signification contribution to the field of memory.State of the artThe characteristics of the five main modular models are presented, including the most recent one (the perceptual-mnemonic model). The differences as well as how these models converge are highlighted.PerspectivesDifferent possibilities that could help reconcile unitary and modular approaches are considered.ConclusionAlthough modular models differ significantly in many aspects, all converge to the notion that memory for single items and semantic memory could be dissociated from memory for complex material and context-rich episodes. In addition, these models converge concerning the involvement of critical brain structures for these stages: Item and semantic memory, as well as familiarity, are thought to largely depend on anterior subhippocampal areas, while relational, context-rich memory and recollective experiences are thought to largely depend on the hippocampal formation.