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.
{"title":"Validation of the French version of the preschool form of the social responsiveness scale-second edition (SRS-2-P)","authors":"Marie-Christine Picot , Cécile Michelon , Julie Loubersac , Amaria Baghdadli","doi":"10.1016/j.encep.2024.05.008","DOIUrl":"10.1016/j.encep.2024.05.008","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the psychometric properties of the French form of the preschool social responsiveness scale-2 (SRS-2-P-Fr).</div></div><div><h3>Participants</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>The SRS-2-P-Fr is a valid instrument for the early detection of ASD in preschool children in France and can facilitate diagnosis.</div></div>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":"51 3","pages":"Pages 300-307"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.encep.2024.03.006
Sidonie Hussenot-Desenonges, Jaqueline Wendland
The Parental Emotion Regulation Inventory 2 (PERI 2) is designed to assess parents’ emotion regulation during discipline interactions with their children. The objective of this study was to examine the psychometric properties of a French translation and adaptation of the PERI 2. Two hundred and forty-six parents of children aged 1 to 3 years old participated in this study. The participants were recruited both face-to-face in a childcare centre and remotely through social networks. They were asked to fill out various questionnaires including the PERI 2 on an online platform. The adequacy indices of the confirmatory analysis were satisfying and validated a 4-factor model. The internal consistency of the overall scale and the subscales was satisfying. The convergent validity of the cognitive reappraisal and expressive suppression factors showed a strong association with the global reappraisal and suppression constructs. The escape factor was positively associated with constructs measuring negative experienced emotion during discipline encounters and physical aggression in children but negatively associated with measures of over reactivity. The capitulation factor was positively associated with constructs measuring negative experienced emotion during discipline encounters, child physical aggression, and global expressive suppression. The association with the laxity factor was negative. The French version of the PERI 2 is a reliable tool to measure cognitive reappraisal and expressive suppression in parents. The tool can be used in research with parents of young children in the context of disciplinary interactions. A short version could also be created for clinical use in order to assess difficulties in the emotion regulation of parents of young children and to assess treatment efficacy.
父母情绪调节量表 2（PERI 2）旨在评估父母在与子女进行管教互动时的情绪调节能力。本研究的目的是检验父母情绪调节量表 2 的法文翻译和改编版的心理测量特性。参加者是在托儿所面对面招募的，也是通过社交网络远程招募的。他们被要求在网络平台上填写包括 PERI 2 在内的各种问卷。确认分析的充分性指数令人满意，并验证了 4 因子模型。总量表和分量表的内部一致性令人满意。认知重评和表达压抑因子的收敛效度表明，它们与总体重评和压抑构念有很强的关联。逃避因子与测量管教过程中的负面情绪体验和儿童的身体攻击行为呈正相关，但与测量过度反应呈负相关。屈服因子与测量管教过程中的负面情绪体验、儿童身体攻击和整体表达压抑的建构呈正相关。与松弛因子的关系则为负相关。法文版 PERI 2 是一种可靠的工具，可用于测量父母的认知再评价和表达压抑。该工具可用于对幼儿家长进行管教互动方面的研究。还可以制作一个简短版本用于临床，以评估幼儿家长在情绪调节方面的困难，并评估治疗效果。
{"title":"French version of the Parental Emotion Regulation Inventory (PERI 2)","authors":"Sidonie Hussenot-Desenonges, Jaqueline Wendland","doi":"10.1016/j.encep.2024.03.006","DOIUrl":"10.1016/j.encep.2024.03.006","url":null,"abstract":"<div><div>The Parental Emotion Regulation Inventory 2 (PERI 2) is designed to assess parents’ emotion regulation during discipline interactions with their children. The objective of this study was to examine the psychometric properties of a French translation and adaptation of the PERI 2. Two hundred and forty-six parents of children aged 1 to 3 years old participated in this study. The participants were recruited both face-to-face in a childcare centre and remotely through social networks. They were asked to fill out various questionnaires including the PERI 2 on an online platform. The adequacy indices of the confirmatory analysis were satisfying and validated a 4-factor model. The internal consistency of the overall scale and the subscales was satisfying. The convergent validity of the cognitive reappraisal and expressive suppression factors showed a strong association with the global reappraisal and suppression constructs. The escape factor was positively associated with constructs measuring negative experienced emotion during discipline encounters and physical aggression in children but negatively associated with measures of over reactivity. The capitulation factor was positively associated with constructs measuring negative experienced emotion during discipline encounters, child physical aggression, and global expressive suppression. The association with the laxity factor was negative. The French version of the PERI 2 is a reliable tool to measure cognitive reappraisal and expressive suppression in parents. The tool can be used in research with parents of young children in the context of disciplinary interactions. A short version could also be created for clinical use in order to assess difficulties in the emotion regulation of parents of young children and to assess treatment efficacy.</div></div>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":"51 3","pages":"Pages 233-239"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.encep.2024.04.004
Ons Mihoub , Arij Ben Chaaben , Wahid Boukouaci , Mohamed Lajnef , Ching-Lien Wu , Jihène Bouassida , Kaori Saitoh , Sobika Sugunasabesan , Soumia Naamoune , Jean-Romain Richard , Hamdi El Kefi , Hanen Ben Ammar , Zouhair El Hechmi , Fathi Guemira , Maher Kharrat , Marion Leboyer , Ryad Tamouza
Objectives
Schizophrenia (SZ) and bipolar disorders (BP) are chronic and severe neuropsychiatric diseases. These disorders are tightly related to immune deregulations. In the current study, we intended to replicate the previously reported involvement of the soluble HLA-E isoforms (sHLA-E) in the risk of developing the two conditions along with disease severity in a Tunisian population group.
Patients and methods
One hundred and twenty-four patients with schizophrenia and 121 with bipolar disorder meeting the DSM-IV criteria along 111 healthy controls were included in this present case-control study. The soluble HLA-E isoforms circulating levels were measured using the ELISA method. The statistical analyses were performed using Kruskal-Wallis and Wilcoxon rank sum tests by R software and GraphPad prism 9.
Results
We found that the sHLA-E circulating levels were significantly higher in BP patients as compared to healthy controls (P < 0.0001) and that such increases were mainly observed in patients during an acute phase of their disease (P < 0.0001). In SZ patients, while we failed to observe an association with the levels of sHLA-E in the entire SZ sample, we found that high sHLA-E levels characterized stabilized patients in comparison with those during an acute episode (P = 0.022). Finally, we did not observe any association between sHLA-E circulating levels and symptoms assessed by the classical clinical scales either in BP or SZ patients.
Conclusion
Overall, the present findings replicate in a Tunisian population group the previously demonstrated implication of sHLA-E circulating levels in the risk of developing BP or SZ in a French patient cohort. Such replication allows to consider HLA-E as a potent and true inflammatory marker in the context of the two disorders.
{"title":"A replication study of sHLA-E influence on schizophrenia and bipolar disorder","authors":"Ons Mihoub , Arij Ben Chaaben , Wahid Boukouaci , Mohamed Lajnef , Ching-Lien Wu , Jihène Bouassida , Kaori Saitoh , Sobika Sugunasabesan , Soumia Naamoune , Jean-Romain Richard , Hamdi El Kefi , Hanen Ben Ammar , Zouhair El Hechmi , Fathi Guemira , Maher Kharrat , Marion Leboyer , Ryad Tamouza","doi":"10.1016/j.encep.2024.04.004","DOIUrl":"10.1016/j.encep.2024.04.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Schizophrenia (SZ) and bipolar disorders (BP) are chronic and severe neuropsychiatric diseases. These disorders are tightly related to immune deregulations. In the current study, we intended to replicate the previously reported involvement of the soluble HLA-E isoforms (sHLA-E) in the risk of developing the two conditions along with disease severity in a Tunisian population group.</div></div><div><h3>Patients and methods</h3><div>One hundred and twenty-four patients with schizophrenia and 121 with bipolar disorder meeting the DSM-IV criteria along 111 healthy controls were included in this present case-control study. The soluble HLA-E isoforms circulating levels were measured using the ELISA method. The statistical analyses were performed using Kruskal-Wallis and Wilcoxon rank sum tests by R software and GraphPad prism 9.</div></div><div><h3>Results</h3><div>We found that the sHLA-E circulating levels were significantly higher in BP patients as compared to healthy controls (<em>P</em> <!--><<!--> <!-->0.0001) and that such increases were mainly observed in patients during an acute phase of their disease (<em>P</em> <!--><<!--> <!-->0.0001). In SZ patients, while we failed to observe an association with the levels of sHLA-E in the entire SZ sample, we found that high sHLA-E levels characterized stabilized patients in comparison with those during an acute episode (<em>P</em> <!-->=<!--> <!-->0.022). Finally, we did not observe any association between sHLA-E circulating levels and symptoms assessed by the classical clinical scales either in BP or SZ patients.</div></div><div><h3>Conclusion</h3><div>Overall, the present findings replicate in a Tunisian population group the previously demonstrated implication of sHLA-E circulating levels in the risk of developing BP or SZ in a French patient cohort. Such replication allows to consider HLA-E as a potent and true inflammatory marker in the context of the two disorders.</div></div>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":"51 3","pages":"Pages 261-266"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141187209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.encep.2025.01.010
Hervé Javelot , Amélie Rousseau
Anticholinergic effects are often identified as adverse drug effects. They can manifest at the central level with cognitive disorders and peripherally with various symptoms such as dry mucous membranes, constipation, urinary retention, or even tachycardia. Several studies have also shown that a high anticholinergic burden may be associated with an increased risk of dementia, hospitalization and even mortality. On the other hand, anticholinesterase drugs, through their protective action on acetylcholine, improve cognitive functions but may cause adverse effects such as diarrhea, urinary incontinence, and bradycardia. Large retrospective cohort studies have also shown that anticholinesterase drugs are associated with a reduced risk of mortality. We thus hypothesize, based on these opposing effects, that the symptomatic improvements, both central and peripheral, observed with anticholinesterase drugs could be linked, at least in part, to the reduction of the anticholinergic burden. Further studies are needed to confirm this hypothesis. These studies should investigate the potential positive correlation between the beneficial effects observed with anticholinesterase drugs and the anticholinergic burden.
{"title":"Beneficial effects of anticholinesterases: Reducing the anticholinergic load, the missing link of the story?","authors":"Hervé Javelot , Amélie Rousseau","doi":"10.1016/j.encep.2025.01.010","DOIUrl":"10.1016/j.encep.2025.01.010","url":null,"abstract":"<div><div>Anticholinergic effects are often identified as adverse drug effects. They can manifest at the central level with cognitive disorders and peripherally with various symptoms such as dry mucous membranes, constipation, urinary retention, or even tachycardia. Several studies have also shown that a high anticholinergic burden may be associated with an increased risk of dementia, hospitalization and even mortality. On the other hand, anticholinesterase drugs, through their protective action on acetylcholine, improve cognitive functions but may cause adverse effects such as diarrhea, urinary incontinence, and bradycardia. Large retrospective cohort studies have also shown that anticholinesterase drugs are associated with a reduced risk of mortality. We thus hypothesize, based on these opposing effects, that the symptomatic improvements, both central and peripheral, observed with anticholinesterase drugs could be linked, at least in part, to the reduction of the anticholinergic burden. Further studies are needed to confirm this hypothesis. These studies should investigate the potential positive correlation between the beneficial effects observed with anticholinesterase drugs and the anticholinergic burden.</div></div>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":"51 3","pages":"Pages 332-334"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Major depressive disorder is a complex neuropsychiatric disorder and one of the leading causes of disability in developed countries. Treatment-resistant depression is defined as the failure of at least two adequate treatment trials. The Muenke Syndrome is an autosomal dominant disorder caused by a mutation of the fibroblast growth factor receptor 3 (FGFR3). The fibroblast growth factor (FGF) family has often been implicated in mood disorders in the literature. We present here the case of a patient with a treatment-resistant depression and a concomitant Muenke Syndrome. We propose a relationship between the two pathologies as the expression of the FGF family has been shown to be dysregulated in depressed humans, post-mortem depressed human's brains and rodent's models of depression and anxiety. In particular, FGFR3 and its major ligand, FGF9, had been shown to be down-regulated and up-regulated, respectively, in cortical areas implicated in mood disorders. Since the FGF family plays a key role in neurodevelopment and neuroplasticity, among others things, a genetic mutation in a member of the family, such as FGFR3, could lead to depressive symptoms, as in our reported case. The implication is that the FGF family may be an important target for the treatment of neuropsychiatric disorders. We also conclude that depressive symptoms should be investigated in cases of Muenke Syndrome, as FGF dysregulation in depressed patients.
{"title":"Treatment resistant depression: A case of Muenke syndrome","authors":"Mélanie Faugere , Michel Cermolacce , Raphaëlle Richieri , Christophe Lançon","doi":"10.1016/j.encep.2024.10.006","DOIUrl":"10.1016/j.encep.2024.10.006","url":null,"abstract":"<div><div>Major depressive disorder is a complex neuropsychiatric disorder and one of the leading causes of disability in developed countries. Treatment-resistant depression is defined as the failure of at least two adequate treatment trials. The Muenke Syndrome is an autosomal dominant disorder caused by a mutation of the fibroblast growth factor receptor 3 (FGFR3). The fibroblast growth factor (FGF) family has often been implicated in mood disorders in the literature. We present here the case of a patient with a treatment-resistant depression and a concomitant Muenke Syndrome. We propose a relationship between the two pathologies as the expression of the FGF family has been shown to be dysregulated in depressed humans, post-mortem depressed human's brains and rodent's models of depression and anxiety. In particular, FGFR3 and its major ligand, FGF9, had been shown to be down-regulated and up-regulated, respectively, in cortical areas implicated in mood disorders. Since the FGF family plays a key role in neurodevelopment and neuroplasticity, among others things, a genetic mutation in a member of the family, such as FGFR3, could lead to depressive symptoms, as in our reported case. The implication is that the FGF family may be an important target for the treatment of neuropsychiatric disorders. We also conclude that depressive symptoms should be investigated in cases of Muenke Syndrome, as FGF dysregulation in depressed patients.</div></div>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":"51 3","pages":"Pages 342-344"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.encep.2024.09.001
Charline El-Hachem , Elina Dirani , Rami Bou Khalil
{"title":"Sur les pas de Pinel, la psychiatrie francophone rayonne sur la Méditerranée","authors":"Charline El-Hachem , Elina Dirani , Rami Bou Khalil","doi":"10.1016/j.encep.2024.09.001","DOIUrl":"10.1016/j.encep.2024.09.001","url":null,"abstract":"","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":"51 3","pages":"Page 341"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.encep.2024.02.011
Emilie Stern , Zélia Breton , Maïa Alexaline , Pierre A. Geoffroy , Catherine Bungener
Digital therapeutic programs are emerging almost daily, offering the potential to reduce healthcare access inequalities by providing more flexible and accessible care options. However, as with traditional healthcare, the issue of patient engagement is fundamental, and the latest research have reported that fewer than 30% of users complete these programs in their entirety. Hence, many authors emphasize the importance of studying the role of therapeutic alliances specifically adapted to digital care. The therapeutic alliance encompasses the collaborative aspects of the relationship between the therapist and the patient. In this context there is a need to reconceptualize the alliance within the context of digital healthcare as it can enhance engagement, adherence, and the effectiveness of such treatments. The objective of this qualitative study was to identify the components of the digital therapeutic alliance. A thematic analysis has identified three major themes that appear to constitute the digital therapeutic alliance among 44 users of an online program: trust in the program, perception of interactions, and feeling of consideration. These results prompted a discussion of the challenges of digital healthcare, including the terminology to use. The term “digital therapeutic adherence” is proposed, thereby opening up a field for research and clarification of this important concept distinct from traditional alliance.
{"title":"Redefining the relationship in digital care: A qualitative study of the Digital Therapeutic Alliance","authors":"Emilie Stern , Zélia Breton , Maïa Alexaline , Pierre A. Geoffroy , Catherine Bungener","doi":"10.1016/j.encep.2024.02.011","DOIUrl":"10.1016/j.encep.2024.02.011","url":null,"abstract":"<div><div>Digital therapeutic programs are emerging almost daily, offering the potential to reduce healthcare access inequalities by providing more flexible and accessible care options. However, as with traditional healthcare, the issue of patient engagement is fundamental, and the latest research have reported that fewer than 30% of users complete these programs in their entirety. Hence, many authors emphasize the importance of studying the role of therapeutic alliances specifically adapted to digital care. The therapeutic alliance encompasses the collaborative aspects of the relationship between the therapist and the patient. In this context there is a need to reconceptualize the alliance within the context of digital healthcare as it can enhance engagement, adherence, and the effectiveness of such treatments. The objective of this qualitative study was to identify the components of the digital therapeutic alliance. A thematic analysis has identified three major themes that appear to constitute the digital therapeutic alliance among 44 users of an online program: trust in the program, perception of interactions, and feeling of consideration. These results prompted a discussion of the challenges of digital healthcare, including the terminology to use. The term “digital therapeutic adherence” is proposed, thereby opening up a field for research and clarification of this important concept distinct from traditional alliance.</div></div>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":"51 3","pages":"Pages 227-232"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.encep.2024.04.006
Elodie Schembri , Elisabeth Jouve , François Poinso , Laure Encely , Marine Viellard , Arnaud Fernandez , Jokthan Guivarch
Autism spectrum disorders (ASD) are neurodevelopmental disorders of varying intensity and disability. The reference health strategy in France for the care of young children with autism is day care hospital (DCH). As the number of places in DCH is insufficient, medically coordinated care programs by the mental health consultation centers (MHCC) are being developed in response.
Objectives
Our objective is to evaluate the effectiveness of a medically coordinated care program in a MHCC versus the care in DCH of child psychiatry.
Methods
Non-inferiority retrospective study comparing the evolution after one year of care of 20 ASD children divided into two groups DCH and MHCC. In the DCH ASD group, the child is taken care of two half-days a week in a day hospital with individual educational care. In the MHCC ASD group, the child benefits from a medically coordinated care program. The medical care is reinforced by more frequent and longer consultations with guidance offered to parents. In both groups, the child receives speech therapy and psychomotor therapy in private practice at the same rate. Comparison is made using a composite criterion associating CARS-2 and VABS-II. Non-inferiority of the medically coordinated care program in autism in reference to DCH was tested on the difference between the changes (DCH group variation – MHCC group variation) with a non-inferiority threshold of 10% of the initial value of each score.
Results
We observed a reduction in autism severity at the CARS-2 and a moderate improvement in socio-adaptive behavior at the VABS-II in both groups. This trend was even more pronounced in the MHCC group than in the DCH group, but only the greater reduction in CARS-2 severity in the MHCC was statistically significant.
Conclusions
As it is necessary to integrate the two scales into the composite criterion, it is not possible to retain the non-inferiority of the MHCC with care program. However, both those children followed in DCH and those in the MHCC care program progress. This shows the relevance of the care offered at the MHCC for children suffering from ASD, in the context of a growing lack of space in DCH. The continuation of this research work through multicenter studies with larger numbers could demonstrate the non-inferiority of coordinated care programs in the MHCC versus DCH. It would also allow subgroups to be set up, taking into account the initial characteristics of the children in order to have more precise indications concerning the relevance of each treatment.
{"title":"Evaluation of a medically coordinated care program in the management of autism","authors":"Elodie Schembri , Elisabeth Jouve , François Poinso , Laure Encely , Marine Viellard , Arnaud Fernandez , Jokthan Guivarch","doi":"10.1016/j.encep.2024.04.006","DOIUrl":"10.1016/j.encep.2024.04.006","url":null,"abstract":"<div><div>Autism spectrum disorders (ASD) are neurodevelopmental disorders of varying intensity and disability. The reference health strategy in France for the care of young children with autism is day care hospital (DCH). As the number of places in DCH is insufficient, medically coordinated care programs by the mental health consultation centers (MHCC) are being developed in response.</div></div><div><h3>Objectives</h3><div>Our objective is to evaluate the effectiveness of a medically coordinated care program in a MHCC versus the care in DCH of child psychiatry.</div></div><div><h3>Methods</h3><div>Non-inferiority retrospective study comparing the evolution after one year of care of 20 ASD children divided into two groups DCH and MHCC. In the DCH ASD group, the child is taken care of two half-days a week in a day hospital with individual educational care. In the MHCC ASD group, the child benefits from a medically coordinated care program. The medical care is reinforced by more frequent and longer consultations with guidance offered to parents. In both groups, the child receives speech therapy and psychomotor therapy in private practice at the same rate. Comparison is made using a composite criterion associating CARS-2 and VABS-II. Non-inferiority of the medically coordinated care program in autism in reference to DCH was tested on the difference between the changes (DCH group variation – MHCC group variation) with a non-inferiority threshold of 10% of the initial value of each score.</div></div><div><h3>Results</h3><div>We observed a reduction in autism severity at the CARS-2 and a moderate improvement in socio-adaptive behavior at the VABS-II in both groups. This trend was even more pronounced in the MHCC group than in the DCH group, but only the greater reduction in CARS-2 severity in the MHCC was statistically significant.</div></div><div><h3>Conclusions</h3><div>As it is necessary to integrate the two scales into the composite criterion, it is not possible to retain the non-inferiority of the MHCC with care program. However, both those children followed in DCH and those in the MHCC care program progress. This shows the relevance of the care offered at the MHCC for children suffering from ASD, in the context of a growing lack of space in DCH. The continuation of this research work through multicenter studies with larger numbers could demonstrate the non-inferiority of coordinated care programs in the MHCC versus DCH. It would also allow subgroups to be set up, taking into account the initial characteristics of the children in order to have more precise indications concerning the relevance of each treatment.</div></div>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":"51 3","pages":"Pages 274-279"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01DOI: 10.1016/j.encep.2024.04.005
Morgane Houix , Ilia Humbert , Fanny D’Acremont , Anne Sauvaget , Jean-François Huon , Samuel Bulteau
Objective
In 2019, a regional survey of potentially inappropriate prescriptions (PIP) of psychotropic drugs in elderly psychiatric inpatients was carried out highlighting their inappropriate use in this population. The aim of this study was to assess the clinical relevance – defined as the provision of an appropriate and necessary treatment, chosen from other alternatives as being the most likely to produce the expected results for a given patient – of these prescriptions considered inappropriate according to current established criteria.
Material and method
Patients aged over 75, or 64 to 75 and polypathological with at least one PIP of psychotropic drugs or drugs with a high anticholinergic burden, identified by an audit grid established on the basis of STOPP/STARTv2 criteria and the Laroche list on the prescription at 48 h of hospitalization, were included. The weighing of the inappropriateness nature of the prescription (resistance to treatment, period of crisis, comorbidities…) was established by a pharmacist-psychiatrist pair on the entire computerized record of the current episode. The clinical relevance of the PIP and the overall prescription was rated as 0 (irrelevant), 1 (partially relevant) or 2 (relevant).
Results
Thirty-four patients were included. One hundred and twenty-five PIP of psychotropic drugs were noted: 50.4% concerned benzodiazepines and non-benzodiazepines anxiolytics (BZD/Z), 25.6% neuroleptics (NL), 12% antidepressants (ATD) and 12% drugs with a high anticholinergic burden. On one hand, 49.2% of PIP of BZD/Z, 50% of PIP of NL and 20% of PIP of ATD were considered irrelevant. On the other hand, 49.2% of PIP of BZD/Z, 31.3% of PIP of NL and 13.3% of PIP of ATD were considered partially relevant. Furthermore, 1.6% of PIP of BZD/Z, 18.8% of PIP of NL and 66.7% of PIP of ATD were considered relevant. For PIPs of drugs with a high anticholinergic burden, 80% were deemed irrelevant, 13.3% partially relevant and 6.7% relevant. In all, of the 34 drug prescriptions studied, three (8.8%) were considered irrelevant, 11 (32.4%) partially relevant and 20 (58.8%) clinically relevant.
Conclusion
This study highlighted the clinical relevance of more than half the prescriptions considered inappropriate according to current PPI criteria in the elderly. It underlines the interest of a new PPI detection tool for elderly patients with psychiatric disorders.
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