Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique最新文献

Background: According to people with a higher weight, physicians are the second most stigmatizing group related to excess weight. As a result of these weight-related biases, the therapeutic relationship with the patient and the quality of care would be negatively affected. In addition, this stigma could negatively impact the clinical practice related to higher weight and avoidance of care.

Objectives: The objective of this study was to assess the stigma of overweight and obesity among psychiatric residents and psychiatrists in France. Specifically, the study aimed to assess factors that may influence weight-related bias among psychiatrists, to explore the relevance of visual assessment of body mass index, and to determine how they this feature is integrated into their practice.

Method: An online questionnaire including sociodemographic items, the Fat Phobia Scale, the Beliefs About Obese Persons Scale, the Body Shape Scales, and questions about their clinical practice was distributed via national professional mailing lists and social networks.

Results: The survey was answered by 271 seniors or residents in psychiatry. The results indicated a moderate level of weight-related bias among psychiatrists as assessed by the Fat Phobia Scale which was higher in residents than in senior psychiatrists. Over a third of the respondents had no material to assess their patient's weight, and two thirds did not systematically assess overweight or obesity. Finally, the results demonstrate that psychiatrists failed to accurately evaluate overweight or obesity based on male or female silhouettes.

Conclusion: It appears that measures should be taken to raise awareness among psychiatrists of the stigmatization of individuals living with a higher weight, as well as to enhance the quality of weight gain care in psychiatry.

Objectives: To evaluate the psychometric properties of the French form of the preschool social responsiveness scale-2 (SRS-2-P-Fr).

Participants: A sample of French children aged 2 to 4 years comprising a group of 93 children with autism spectrum disorder (ASD) and a community control group of 201 children.

Materials and methods: Study of internal consistency using Cronbach's α coefficient, convergent validity using correlations with the ADI-R and ADOS-2, and diagnostic accuracy using the receiver operating characteristic curve to determine the best threshold scores useful for screening ASD in preschool children.

Results: Good internal consistency (0.78 to 0.98) according to Cronbach's alpha coefficients for the total score and the sub-scores of the SRS-2-P scale. The study of convergent validity showed strong correlations with the total score of the ADOS-2 Toddlers and the communication and reciprocal social interaction sub-scores of the ADI-R. Diagnostic accuracy indicated that the best cut-off score for detecting ASDs was 56 (area under the curve=0.97, sensitivity 0.925, specificity 0.98).

Conclusion: The SRS-2-P-Fr is a valid instrument for the early detection of ASD in preschool children in France and can facilitate diagnosis.

Objectives: Preventing minor-attracted persons from acting on their impulses is a significant public health concern. To address this, the STOP telephone helpline was established nationwide in France in January 2021. This service acts as a bridge, connecting callers with their nearest CRIAVS (resource centers for professionals working with sex offenders) where they can speak with a healthcare professional who can guide them toward appropriate care if needed. Our study is a detailed look at the STOP service's activity from January 1st, 2021, to December 31st, 2022, covering a span of 24 months.

Method: We developed a structured approach to collecting data for analysis. Data were extracted from the centralized database of the STOP service, allowing for the collection of quantitative variables and qualitative variables.

Results: Over the study period, there were 5442 calls made to the service. After filtering out calls that were unsuccessful or too short (mostly under 5minutes), we analyzed 369 records. Among these, 79.1% were first-time callers, with 73.3% of them admitting to being attracted to children, a group which predominantly consisted of men. Notably, 46.7% of callers expressing an attraction to children were referred to further care. In total, 72.6% of callers learned about the service through media channels.

Conclusion: Analysis revealed that the STOP service was primarily utilized by the intended audience-minor-attracted persons. The gradual decline in call volume over time and the reliance on media for awareness highlight the importance of widespread publicity. The findings from our study, spanning twenty-four months of the STOP service's operation, highlight the value of having such a platform available to facilitate access to mental health support for minor-attracted persons. They emphasize the need for increased communication efforts to promote the STOP service and call for further data analysis to enhance its effectiveness.

Objectives: The aim of this study was to validate the questionnaire "Body-Esteem Scale for Adolescents and Adults" (BESAA).

Methods: We conducted a cross-sectional study involving 340 adolescents who attend a Tunisian high school. We translated the BESAA into dialectal Tunisian Arabic based on the translation back-translation method. The validity of the scale was evaluated through content validity, reliability and construct validity. We used the Arabic version of the Rosenberg Self-Esteem Scale as an external validator. The cut-off of the scale was calculated using the ROC curve.

Results: The translated version was considered satisfactory. The exploratory analysis related three factors similar to the original version of the questionnaire. We dropped eight items (1, 4, 6, 14, 15, 18, 19 and 23) and obtained a 15-item version. A principal component analysis was carried out of the new version and produced a three-component solution that accounted for 64.56% of the total BESAA variance. In confirmatory analysis, the scale demonstrated good model fit statistics as follows: Comparative Fit Index=0.92; Goodness of Fit Index=0.89; Adjusted Goodness of Fit Index=0.85; Root Mean Square Error of Approximation=0.13 and Standardized Root Mean Square Residual=0.09. The internal consistency showed a good result with a Cronbach's alpha of 0.753. The correlation between items and subscales demonstrated statistically significant and logical results. Statistically significant correlations were found between the BESAA and its external validator the Rosenberg Self-Esteem Scale (r=0.382; P<0.01). The cut-off of our scale was equal to 24.5.

Conclusions: The Tunisian 15-item version of the BESAA is a psychometrically valid measure. This scale can be reliably used to conduct further studies and research on body esteem in the Tunisian population.

Background: Functional somatic disorder (FSD) is a prevalent disorder that can be severely disabling for the patient and is associated with major health costs. There are few formalized care programs for these disorders in the country, and their management encounters various difficulties, both in the diagnosis and its announcement and the treatment. Cognitive-behavioural and emotional therapy (CBT) is the standard on psychiatry care, and its efficacy has been demonstrated through several randomised controlled studies on the intensity of physical and psychological symptoms.

Intervention: At Lille's University Hospital Center, we have established the "ACSEPT" care pathway for TSF management which consists of a psychiatric consultation followed by an individual referral, including a treatment using repeated transcranial magnetic stimulation (rTMS) or the integration of a CBT-based psychoeducation group. This group had the particularity of caring for all patients presenting FSD regardless of the associated physical symptoms. Educating medical professionals and conducting FSD research were other goals of ACSEPT.

Discussion/conclusion: ACSEPT allows an improvement in the care offered to these patients with a defined orientation and interdisciplinary, early, organized cares that are repeatable. Our goal is to study the effectiveness of these different interventions in subsequent studies, to continue the development of ACSEPT and to be able to distribute this intervention at the regional level to establish a clear care program allowing early management of these patients.

The concept of multimorbidity in psychiatry refers to the coexistence of multiple health conditions without conceptualizing a central disorder referring to a patient-centered approach that views every diagnosis equally. It emphasizes a shift from focusing on an index disorder to considering interrelated symptoms crucial in psychiatry due to frequent multimorbidity patterns. In clinical practice, multimorbidity guides patient-centered care helping to address the holistic needs of patients and challenging the organization of mental health care. In research, multimorbidity reshapes study outcomes and promotes the development of patient-reported outcome questionnaires, also posing ethical challenges and advocating for the inclusion of multimorbid patients in personalized interventions. Finally, multimorbidity in psychiatry has public health implications aligning with the socioecological systems perspective. This notion aims to improve prognosis, care, and health costs while impacting global mortality and challenging the conceptualization and organization of psychiatric care.

Dementia is a highly prevalent syndrome with various causes, characterized by cognitive deficit in one or more domains, with important impairment of functioning, which frequently presents with neuropsychiatric symptoms that may include obsessive-compulsive symptoms.

Objectives: The main goal of this meta-analysis was to describe and determine the prevalence of obsessive-compulsive symptoms in dementia.

Materials and methods: To accomplish that, MEDLINE, CENTRAL and Psycnet databases were searched from inception to March 2023. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data was applied. The principal summary measures were the mean of prevalence of obsessive-compulsive symptoms in patients with dementia and the number of each type of obsession or compulsion.

Results: Of the 643 articles screened, 92 were accepted for full-text assessment. Of these, 30 with information on prevalence of obsessive-compulsive symptoms in dementia or any description of those were included, yielding a total of 37 cohorts (5 studies with two cohorts and 1 study with three cohorts). According to our results, obsessive-compulsive symptoms have considerable prevalence in dementia (35.3%, 23.1-47.6%), namely in frontotemporal dementia (48.4%, 29.8-67.0%); obsessive-compulsive symptoms were less frequent in other dementia diagnosis (17.6%, 9.1-26.2%). The more frequent obsessive contents are symmetry (28.6%) and somatic (20.0%); and the more frequent compulsions are checking (27.4%); hoarding is also a relevant symptom (27.8%).

Discussion: There was considerable heterogeneity in the prevalence of obsessive-compulsive symptoms in frontotemporal dementia, that is, in part related with diagnostic criteria for dementia, as well as obsessive-compulsive symptom assessment. A careful distinction between compulsions and compulsive-like symptoms is fundamental. Hypervigilance for somatic symptoms and concerns about disease and mortality, as well as deficits in cognitive domains like attention and memory may explain why somatic obsessions and checking compulsions are more prevalent.

Conclusions: The present results indicate that obsessive-compulsive symptoms may be prevalent in the clinical course of many patients with dementia, especially frontotemporal dementia. Better instruments are needed to describe obsessive-compulsive phenomena in a reliable and comparable way, particularly in a population such as dementia patients, whose subjectivity is difficult to access.

Introduction: During operational missions, while the management of physical injuries in the field remains the priority, the identification of operational incapacity of psychological origin is necessary as it is equally crucial for the safety of the individual, the group and the mission. The French Military Health Service has developed a Psychological First Aid Training in Operation (PFATO) course based on relational simulations, for military service members. The aim is to identify the early signs of psychological distress in a comrade and to adopt an adapted and protective attitude. PFATO training is also offered to healthcare providers.

Methods: We conducted a descriptive cross-sectional study using a self-administered online questionnaire which was sent after deployment to all physicians or nurses trained in PFATO between July 2019 and July 2021 (n=80). The main objective of our work was to evaluate the relevance of this awareness training among physicians and nurses and to identify specific complementary expectations in operational psychiatry for this population.

Results: We obtained a response rate of 55%. Significantly, 21.62% of participants used PFATO during their last deployment and another 20% observed a team member using PFATO. The circumstances of use as reported by participants included acute stress related to combat, conflict with hierarchy or comrades, and suicidal crisis. Among those who used PFATO, the training helped 87.5% of them to identify signs of psychological distress and 100% of them to assist combatants . All respondents stressed the added value of practical simulations during PFATO education. Moreover, this study also makes it possible to identify adaptations needed to optimize this module for healthcare providers.

Conclusion: The results suggest the value for healthcare provider of training in first-response psychological care using relational simulation based on the model of raising awareness about PFATO.