Troubles du sommeil de l’adolescent associés à un absentéisme scolaire : le pédopsychiatre est souvent déterminant pour une prise en charge efficace en consultation de somnologie

National audienceIntroductionAdolescent sleep is characterized by a physiological delayed sleep phase disorder frequently exacerbated by the intensive use of information and communication technologies. The sleep restriction thus induced during schooling has consequences on the physical and psychological health of the adolescent. On the other hand, the sleep complaint may correspond to psychiatric disorders in the adolescent. Thus, when this complaint is associated with school absenteeism, the management of sleep alone is often insufficient. In order to understand the reason for this inefficiency, we wanted to better characterize the profile of these adolescents.MethodWe have developed a somnological and psychiatric “screening kit” resulting in a management decision tree. This kit was tested in 2017 as part of joint consultations at the Lyon Sleep Center in adolescents who presented a complaint of sleepiness or insomnia associated with school absenteeism.ResultsThese preliminary results on 11 patients show the predominance of a delayed sleep phase syndrome or an absence of sleep diagnosis associated in more than 90 % of cases with anxiety-depressive difficulties ranging from the mood depressive disorder to the school refusal behavior and underlying anxiety disorders. Somatization is also common.ConclusionThese first data seem to confirm the need for a child and adolescent psychiatric assessment to deal with the psychological difficulties of these adolescents in parallel with their sleep complaint so as to offer them the best chances of improvement, re-schooling and social insertion.IntroductionLe sommeil de l’adolescent est caractérisé par un retard de phase physiologique fréquemment exacerbé par l’utilisation intensive des technologies d’information et de communication. La restriction de sommeil ainsi induite en période scolaire a des conséquences sur la santé physique et psychologique de l’adolescent. D’autre part, la plainte sommeil peut correspondre à un certain nombre de troubles pédopsychiatriques chez l’adolescent. Ainsi lorsque cette plainte s’associe à un absentéisme scolaire, la prise en charge somnologique seule s’avère souvent insuffisante. Afin de comprendre le pourquoi de cette inefficacité, nous avons revu cette problématique selon le point de vue du sommeil et de la pédopsychiatrie, puis souhaité mieux caractériser le profil de ces adolescents.MéthodePour cela nous avons élaboré un « kit de dépistage » somnologique et pédopsychiatrique duquel découle un arbre décisionnel de prise en charge. Ce kit a été testé sur l’année 2017 dans le cadre de consultations conjointes au centre du sommeil de Lyon auprès des adolescents consultants pour une plainte de somnolence ou d’insomnie associée à un absentéisme scolaire.RésultatsLes résultats préliminaires sur 11 patients, montrent la prédominance d’un retard de phase du sommeil ou d’une absence de diagnostic sommeil associé dans plus de 90 % des cas à des difficultés anxiodépressives allant de l’épisode dépressif caractérisé aux situations de refus scolaire anxieux et ses troubles anxieux sous-jacents. Les somatisations sont également fréquentes.ConclusionCes premières données semblent confirmer la nécessité d’une évaluation pédopsychiatrique afin de prendre en charge les difficultés psychologiques de ces adolescents en parallèle de leur plainte sommeil et ainsi de leur offrir les meilleures chances d’amélioration, de rescolarisation et d’insertion sociale

Cognitive Behavioral Therapy and Acceptance and Commitment Therapy for the Discontinuation of Long-Term Benzodiazepine Use in Insomnia and Anxiety Disorders.

Benzodiazepines have proven to be highly effective for treating insomnia and anxiety. Although considered safe when taken for a short period of time, a major risk-benefit dilemma arises in the context of long-term use, relating to addiction, withdrawal symptoms, and potential side effects. For these reasons, benzodiazepines are not recommended for treating chronic sleep disorders, anxiety disorders, nor for people over the age of 65, and withdrawal among long-term users is a public health issue. Indeed, only 5% of patients manage to discontinue using these drugs on their own. Even with the help of a general practitioner, this rate does not exceed 25 to 30% of patients, of which approximately 7% manage to remain drug-free in the long term. Cognitive Behavioral Therapies (CBT) offer a crucial solution to this problem, having been shown to increase abstinence success to 70-80%. This article examines traditional and novel CBT techniques in this regard, such as Acceptance and Commitment Therapy, which address both the underlying condition (insomnia/anxiety) and the substance-related disorder. The theoretical framework and evidence supporting the use of these approaches are reviewed. Finally, current research gaps are discussed, and key research perspectives are proposed

Secondary findings from whole-exome/genome sequencing evaluating stakeholder perspectives. A review of the literature

IF 2.004 (2017)International audienceWith the development of next generation sequencing, beyond identifying the cause of manifestations that justified prescription of the test, other information with potential interest for patients and their families, defined as secondary findings (SF), can be provided once patients have given informed consent, in particular when therapeutic and preventive options are available. The disclosure of such findings has caused much debate. The aim of this work was to summarize all opinion-based studies focusing on SF, so as to shed light on the concerns that this question generate. A review of the literature was performed, focusing on all PubMed articles reporting qualitative, quantitative or mixed studies that interviewed healthcare providers, participants, or society regarding this subject. The methodology was carefully analysed, in particular whether or not studies made the distinction between actionable and non-actionable SF, in a clinical or research context. From 2010 to 2016, 39 articles were compiled. A total of 14,868 people were interviewed (1259 participants, 6104 healthcare providers, 7505 representatives of society). When actionable and non-actionable SF were distinguished (20 articles), 92% of respondents were keen to have results regarding actionable SF (participants: 88%, healthcare providers: 86%, society: 97%), against 70% (participants: 83%, healthcare providers: 62%, society: 73%) for non-actionable SF. These percentages were slightly lower in the specific situation of children probands. For respondents, the notion of the «patient's choice» is crucial. For healthcare providers, the importance of defining policies for SF among diagnostic lab, learning societies and/or countries is outlined, in particular regarding the content and extension of the list of actionable genes to propose, the modalities of information, and the access to information about adult-onset diseases in minors. However, the existing literature should be taken with caution, since most articles lack a clear definition of SF and actionability, and referred to hypothetical scenarios with limited information to respondents. Studies conducted by multidisciplinary teams involving patients with access to results are sadly lacking, in particular in the medium term after the results have been given. Such studies would feed the debate and make it possible to measure the impact of such findings and their benefit-risk ratio