Relevance of Brain 18F-FDG PET Imaging in Probable Seronegative Encephalitis With Catatonia: A Case Report

Autoimmune encephalitis (AIE) is a rare, severe, and rapidly progressive encephalopathy, and its diagnosis is challenging, especially in adolescent populations when the presentation is mainly psychiatric. Currently, cerebral 18-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) imaging is not included in the diagnosis algorithm. We describe a 16-year-old patient with probable seronegative encephalitis with catatonia for which several cerebral PET scans were relevant and helpful for diagnosis, treatment decision making, and follow-up monitoring. The patient recovered after 2 years of treatment with etiologic treatment of AIE and treatment of catatonia. This case suggests a more systematic assessment of the clinical relevance of 18F-FDG-PET imaging in probable seronegative AIE

Changes in the Use of Emergency Care for the Youth With Mental Health Problems Over Decades: A Repeated Cross Sectional Study

To understand whether changes exist in the types of youths mental health problems addressed in emergency in a context of increasing demand, we conducted a retrospective chart review in an emergency care outpatient unit. Data from children and adolescents admitted at four different time periods (years 1981, 1992, 2002, and 2017) were compared to determine trends in terms of patients' characteristics, nature of the mental health problems and final care decisions. Between 1981 and 2017 there was a 3.85 times increase in the annual number of patients presenting to the emergency consultations. The proportion of youths being referred for anxiety or depressive symptoms sharply increased over time, while no differences were found for the proportion of aggressive behaviors and suicidal attempts. Anxiety disorders became the most frequent discharge psychiatric disorder in youths admitted in the emergency unit, rising from 5% in 1981 to 34% in 2017. Significant changes were also observed in the source of referral to the emergency unit; in particular emergency consultations in 2017 were about twice as likely as in 1981 to be requested directly by the family. This data suggested that the increased use of emergency services observed over the last decades is associated with significant changes in the patient and his/her family's demands about mental health difficulties. Such findings are worth considering for mental health interventions that aim to address the emergency overcrowding issue

Psychose émergente chez l'adolescent et le jeune adulte : l'accès aux soins en question : À partir des données du centre pilote français de détection et d'intervention précoces

Since the 1990s, research in the field of early detection and intervention for psychotic disorders has been widely developed. The aim is to identify those at risk of developing these disorders in order to prevent or delay the onset of the disease and limit its psychosocial consequences. Today, there are hundreds of centers in the world that specialize in this preventive approach. In France, the pilot center is the C'JAAD, an evaluation center for adolescents and young adults in Sainte-Anne hospital in Paris. According to data collected from 330 subjects received at the C'JAAD, we sought to identify the determinants of access to care for these early intervention centers. We used mixed methods, combining quantitative and qualitative analyzes to offer a better understanding of this complex issue. We observed that access to care is a multifactorial process that depends in particular on displayed symptoms, degree of experienced stigmatization, mobilization of the entourage and training of primary care professionnals. Starting from a historical perspective of the concept of subjects "at risk of psychosis" and in light of our findings taking into account the specificities of our health care system, we attempt a reflexive approach to this paradigm of Early Intervention in Psychiatry and propose suggestions to improve prevention of psychotic disorders in France.Depuis les années 1990, la recherche dans le champ de la détection et de l'intervention précoces des troubles psychotiques s'est largement développée. L'objectif est d'identifier les sujets à risque de développer ces troubles afin de prévenir ou de retarder l'apparition de la pathologie et d'en limiter les conséquences psychosociales. On compte aujourd'hui une centaine de centres spécialisés dans cette approche préventive à travers le monde. En France, le centre pilote est le C'JAAD, Centre d'évaluation des Jeunes Adultes et des ADolescents à l'hôpital Sainte-Anne à Paris. À partir de données recueillies auprès de 330 sujets reçus au C'JAAD, nous avons cherché à identifier les déterminants de l'accès à ces centres d'intervention précoces. Nous avons utilisé les méthodes mixtes, associant analyses quantitatives et qualitatives dans le but d'une meilleure compréhension de cette problématique complexe. Nous avons observé que l'accès aux soins est un processus multifactoriel qui dépend notamment des symptômes présentés, du degré de stigmatisation éprouvée, de la mobilisation de l'entourage et de la formation des intervenants de première ligne. En nous inscrivant dans la perspective historique du concept de sujets « à risque de psychose » et à la lumière des résultats de notre étude ainsi que des spécificités de notre système de soins, nous tentons une approche réflexive quant à ce paradigme de l'intervention précoce en psychiatrie et proposons des pistes de leviers d'amélioration de la prévention des troubles psychotiques en France

Do Radicalized Minors Have Different Social and Psychological Profiles From Radicalized Adults?

International audienceIntroduction: Radicalization is a major issue in Western societies. Supposedly, there is no predefined pathway leading to radicalization. However, youth appears to be at risk for radicalization. The aim of this study was to compare the social and psychological profiles of radicalized minors and radicalized adults.Methods: This cross-sectional study is based on the first large prospective sample of young French individuals (N = 150) who aimed to join the Islamic State (IS) between 2014 and 2016. This sample included 70 adolescents (mean age 15.82 years old, SD 1.14) and 80 young adults (mean age 23.32 years, SD 4.99). We compared the two groups on their sociodemographic and psychological characteristics.Results: Radicalized minors and radicalized adults have different profiles and follow different paths in the radicalization process. Among the group of minors, there are significantly more female subjects (81.4% versus 55.0%, adj. p = 0.007) and more self-harm history before radicalization (44.3% versus 16.2%, p <0.001). In addition, there are significantly less attempts to radicalize the entourage (24.3% versus 50.0%, adj. p = 0.007), and a tendency to show less cases of radicalization among the entourage (32.9% versus 52.5%, adj. p = 0.075) and less radicalization through physical encounter (45.7% versus 65%, adj. p = 0.082).Discussion: Overall, radicalized minors appear to be more psychologically vulnerable individuals than radicalized adults. These differences highlight the importance of tailored interventions in order to prevent radicalization among vulnerable adolescents

Changes in the Use of Emergency Care for the Youth With Mental Health Problems Over Decades: A Repeated Cross Sectional Study

International audienceTo understand whether changes exist in the types of youths mental health problems addressed in emergency in a context of increasing demand, we conducted a retrospective chart review in an emergency care outpatient unit. Data from children and adolescents admitted at four different time periods (years 1981, 1992, 2002, and 2017) were compared to determine trends in terms of patients' characteristics, nature of the mental health problems and final care decisions. Between 1981 and 2017 there was a 3.85 times increase in the annual number of patients presenting to the emergency consultations. The proportion of youths being referred for anxiety or depressive symptoms sharply increased over time, while no differences were found for the proportion of aggressive behaviors and suicidal attempts. Anxiety disorders became the most frequent discharge psychiatric disorder in youths admitted in the emergency unit, rising from 5% in 1981 to 34% in 2017. Significant changes were also observed in the source of referral to the emergency unit; in particular emergency consultations in 2017 were about twice as likely as in 1981 to be requested directly by the family. This data suggested that the increased use of emergency services observed over the last decades is associated with significant changes in the patient and his/her family's demands about mental health difficulties. Such findings are worth considering for mental health interventions that aim to address the emergency overcrowding issue