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

Psychiatric wards that only exceptionally use isolation and mechanical restraint may be suspected of using "chemical restraint". However, in the case of these services, the hypothesis of a reduction in the general level of restraint can also be formulated. Prior to a comprehensive study to test these hypotheses, the current research aims to assess indicators which define high levels of the use of these measures and a relevant sample. The study was conducted in three facilities with 254 hospitalized patients over a week. Five per cent experienced isolation, 2% mechanical restraint, and 13% received high doses of medication (including "as needed" treatments). These figures are below literature data and national averages. Variances exist among centers, with one showing higher percentages for all three measures. While confirming the feasibility of studying these measures together, the study suggests the need for longer observations and continuous evaluation of prescription practices to better reflect yearly isolation and restraint trends. Future studies should involve more centers and include case studies for a nuanced understanding of administration practices in relation to prescriptions.

Young, isolated migrants (YIMs) represent some particularly vulnerable populations that have arrived unaccompanied on the national territory and are particularly exposed to mafia networks, delinquency, and prostitution. YIMs thus cumulate social (e.g., precarity, or isolation), psychiatric (e.g., post-traumatic stress disorder, mood, or anxiety disorders), and addiction (e.g., prescription drug dependence) disorders. This addition of vulnerabilities makes the social and medical support difficult to operationalize as it requires multidisciplinary and coordinated programs. In Lyon, the 2nd-largest urban agglomeration in France, the "Dispositif d'accompagnement en Réseau pour l'accès aux soins psychiatriques et addictologiques des jeunes migrants en errance à Lyon" (DARJELY), ("Network System for supporting psychiatric and addiction care to YIMs in Lyon") has been implemented since early 2023 and gathers the following components: (i) a coordinating pair of professionals (i.e., a street worker and an addiction nurse) who ensure a case management of individual situations and articulate the medical and social support with external partners, (ii) an addiction medicine team, (iii) a psychiatric team working at the same place as the addiction medicine team, and (iv) a socio-educational team that can meet YIMs "in situ" and refer them into care, in particular toward teams (ii) and (iii). Overall, DARJELY is thus an innovative system which offers multidisciplinary and coordinated missions toward YIMs including: (i) meeting YIMs on the ground and referring them to specialized care units through the coordination team; (ii) orchestrating the follow-up with other social or medical stakeholders on the local territory; (iii) collecting and synthetizing data for local decision-makers and partners; and (iv) producing research data for improving the understanding of these hard-to-reach populations. All these missions meet current needs of public health regarding these complex populations whose number has been constantly increasing over the recent years.

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.

Objectives: It is known that lockdown alters the mental health of children in general and adolescents in particular. Here, we surveyed the mental health of high school students returning to in-class lessons after the pandemic. We compared an "anxious-depressed" group with a "neither anxious nor depressed" group with regard to perceived self-efficacy.

Methods: Students from a high school in the Rhône-Alpes region of France participated in a mental health survey. After the students had been given a study information sheet and had agreed to participate, they filled out three paper-based questionnaires the State-Trait Anxiety Inventory for Children (STAI-C), the Center for Epidemiological Studies-Depression (CES-D) self-questionnaire, and the Self-Efficacy Questionnaire for Children (SEQ-C) on an anonymous basis.

Results: A total of 709 datasets were analyzed. The participants' mean±standard deviation age was 15.89±0.93. The group comprised 438 girls, 251 boys, and 20 participants who did not state their sex. Compared with the boys, the girls had significantly higher scores in the STAI-C and CES-D questionnaires. According to the SEQ-C, the boys felt significantly more effective than the girls overall and for social efficacy and emotional efficacy. In contrast, the boys and girls did not differ regarding the academic efficacy score. Our main findings were that 53% (n=379) of the high school students were reportedly free of anxiety or depression, 28% (n=198) showed symptoms of subclinical anxiety and depression, and 19% (n=131) showed symptoms of clinical anxiety or depression. We compared the "anxious-depressed" group with the "neither anxious nor depressed" group: the former group was mainly composed of girls, whereas there were nearly as many boys as girls in the latter group. After adjustment for sex, the overall self-efficacy and the academic, social and emotional efficacy scores were found to be lower in the "anxious-depressed" group. The sex difference was null for social efficacy, small for overall efficacy and academic efficacy, and moderate for emotional efficacy.

Conclusions: Overall, 47% of the study participants reported subclinical anxiety and/or a depression. It appears that anxiety and depression are linked to self-efficacy: the self-efficacy score was lower in the "anxious-depressed" group than in the "neither anxious nor depressed" group.

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.

Objectives: Therapeutic response in depression is a major challenge since more than one third of patients are not in remission after two attempts of antidepressant treatment and will present a treatment-resistant depression. In order to better adapt therapeutic strategies for treatment-resistant patients, predictive indicators and markers of therapeutic response still need to be identified. In parallel, patients with depression exhibit disturbances in cognitive functioning. This study aims to describe and compare cognitive performances collected at inclusion of patients presenting treatment-resistant depression who will be responders at 6 months to those of non-responders, and to evaluate the predictive value of cognitive indicators on clinical therapeutic response at 6 months after a therapeutic modification.

Methods: Observational study. Patients were evaluated at the clinical (HDRS and BDI-II) and cognitive levels using standardized tools assessing memory, executive functions, attention, and social cognition, prior to a change in antidepressant treatment. Six months after inclusion, they were reassessed and classified into two groups based on the presence or absence of therapeutic response, defined by a 50% improvement on HDRS and BDI-II. The cognitive scores collected at inclusion were then compared. Additionally, univariate logistic regression models were used.

Results: Thirty patients were included in this study. Only 13 could be evaluated at 6 months. Among these patients, four had responded to the new treatment while nine were non-responders. Both groups of patients presented deviant cognitive performances compared to norms on tests evaluating executive functions and attention. Statistical analyses did not reveal any difference between the cognitive performances of responders and non-responders at 6 months. Regression analyses showed no association between cognitive scores and therapeutic response at 6 months.

Conclusion: Executive functioning plays a significant role in treatment-resistant depression. In order to improve the understanding and identification of subtypes of depression, cognitive indicators should be systematically integrated into future research.

Objective: This study aims to examine the specificities of intimate partner sexual violence among heterosexual partners, as well as to contrast them to the sexual violence perpetrated by strangers or acquaintances.

Method: A narrative review was conducted to identify relevant findings in the scientific and medical literature to inform about intimate partner sexual violence. Findings were also analysed with the lens of the clinical experience of the authors working with men convicted of intimate partner sexual violence.

Results: Intimate partner sexual violence was legally recognized by article 222-22 of the French Penal Code in 2006. In France rape committed by intimate partners accounts for 34% of rapes of adult women. Intimate partner sexual violence is likely to be underestimated due to variables of individual, relationship, community, and societal levels. Despite a common perception that intimate partner sexual violence is located at the lower end of the severity continuum compared with other forms of sexual violence, studies have shown that intimate sexual violence is as or even more harmful to a woman. Compared to victims of other types of sexual violence, women sexually abused by an intimate partner experience more severe mental health outcomes such as depression, anxiety, anger, self-blame, increased feelings of shame, post-traumatic stress disorder, substance abuse to cope or suicide attempt. Intimate partner sexual violence is also associated with humiliation and betrayal of trust, greater physical violence, greater risk of sexually transmitted infections, re-victimization, higher risk of serious injury or homicide. Beyond the legal definition of sexual rape, intimate partner sexual violence encompasses a wide range of subtle and complex behaviors such as coercive tactics, blackmail, implicit threat or reproductive control. The COVID-19 pandemic lockdown seems to have played a "revealing" or "aggravating" role rather than a "triggering" of intimate violence. The treatment of intimate partner sexual violence is complex and should consider diverse therapeutic strategies to deconstruct the offenders' societal misrepresentations and to make them aware of their partner's inter-subjectivity.

Conclusions: Identifying and understanding intimate partner sexual violence need to be improved both to refine the treatment of the offender-victim dyad and to break down the toxic relational dynamics maintaining abusive behaviors.

Introduction: Dissociation is a psychological process in reaction to threat which can be found in many psychiatric conditions. Dissociative symptoms can become very disabling, whether in daily life or in care. Nevertheless, few studies seem to have examined the efficacy of psychotherapy on the latter and its relevance as a therapeutic target.

Method: A systematic review of the literature (PRISMA) on the efficacy of psychotherapy on dissociative symptoms in adults with mental disorders was conducted. Effectiveness was considered in terms of reduction in dissociative symptomatology. The search was conducted on Scopus, PubMed and PsycInfo. Overall, 50 full-text articles were evaluated.

Results: Fourteen studies were included in the review. In all, 711 adult subjects with post-traumatic stress disorder, borderline personality disorder or dissociative disorder were included. Overall, this systematic review reports a reduction in dissociative symptoms associated with a variety of psychotherapeutic interventions, without allowing any conclusions to be drawn on the superiority of one psychotherapy over another.

Discussion: The conclusions of this work highlight three possible therapeutic orientations for reducing dissociative symptoms: (i) by reintegrating the dynamic subsystems, (ii) by treating the cognitive processes underlying dissociation, and (iii) by acting on the processes identified as common to the effectiveness of psychotherapy.