Pourquoi et comment soigner plus précocement les troubles psychotiques?

Chronic psychosis, as for instance schizophrenia, usually begins in young adulthood and may cause severe disability. It causes a mean loss of life expectancy of 22 years. Actual models of psychosis do not trace the beginning of psychosis to the first franc psychotic episode only, but to earlier symptoms. In a classical health system only considering the first psychotic episode, the mean duration of untreated illness (DUI) can last several years. Yet this DUI has a direct impact on the prognosis of the disease. Actual international recommendations prescribe to early detect and treat at risk mental states of psychosis, thus reducing DUI. Such an attitude also helps the patient to integrate care in a moment where she/he is fully in condition to consent and to adhere. Generalist practitioners are crucial actors of early detection. We describe here simple and standardized tools helping early detection of high-risk mental states of psychosis in primary care and the appropriate attitude to do it properly. Numerous countries have developed early detection and treatment centers for psychosis. It has been established that such interventions clearly decrease the risk of transition towards chronic psychosis and improve the prognosis. These recent data about early detection and intervention in psychosis are a major step forward in psychiatry practice. It is now necessary to largely develop such actions in France

Adolescence and suicide attempt : psychosocial outcomes, social support, risk factors and prevention of suicide recurrence

Contexte : La tentative de suicide (TS) concerne 8 à 10 % des adolescents et la récidive précoce 14 à 20% des adolescents. La TS peut avoir des répercussions à long terme chez les adolescents, tant au niveau scolaire/professionnel, qu’au niveau affectif et psychique. Objectifs : 1) Décrire le devenir psychosocial des suicidants et le poids de la récidive sur ce devenir, 2) étudier l’impact du fait de ne plus être joignable par l’équipe de soins 1 an après la TS et 3) étudier les modalités de communication, le soutien social et la santé perçue des jeunes suicidants. Méthode : 1) 309 sujets ont été inclus avec une évaluation au moment du geste et à 10 ans, 2) étude de l’association du fait de ne plus être joignable par l’équipe de soins avec la récidive suicidaire chez 249 patients, 3) modalité d’utilisation des moyens de communication, perception du soutien social et santé perçue de 58 adolescents suicidants. Résultats : Devenus adultes, les jeunes suicidants ont un devenir psychosocial altéré, d’autant plus lorsqu’ils avaient récidivé durant l’année suivant le geste d’inclusion. Le fait de ne plus être joignable par les soignants un an après la TS d’inclusion majore le risque de récidive suicidaire dans les 10 ans. Chez les suicidants, l’utilisation des SMS est privilégiée pour « rester en lien » avec les proches ; soutien social et santé perçue sont évalués de manière moins positive que chez leurs pairs. Perspectives : Dans un but de prévention de la récidive, nous avons développé un dispositif de veille s’appuyant sur l’envoi de SMS qui sera évalué dans un essai randomisé contrôlé.Background: Suicide attempt (SA) concerns 8% to 10% of adolescents and SA recurrence within the year 14% to 20% of adolescents. SA of young patients may have implications over the long term on an academic/professional level, as well as on an affective and psychic level. Objectives: 1) To describe psychosocial outcomes of SAers and the weight of recurrence on these outcomes, 2) to study the impact of losing contact with caregivers during the year following SA, and 3) to study how young SAers use means of communication, and perceive social support they receive and their health-related quality of life. Methods: Three researches were carried out on adolescent SAers. 1) 309 SAers were evaluated at time of SA and 10 years after SA, 2) study of the correlation between a loss of contact with caregivers and SA recurrence occurring between 1 to 10 years after the initial SA of 249 young patients, 3) how 58 SAers use means of communication, and perceive social support they receive and their health-related quality of life. Results: As an adult, the psychosocial situation of young SAers is impaired, especially for those who have a recurrence of SA during the year after index SA. The risk of recurrence increases in the ten years following index SA for early SAers, and in the year following index SA when contact has been lost with caregivers. SAers preferentially use SMS to “keep in touch” with relatives and they assess on a less positive note than peers their social support and health-related quality of life. Perspectives: We developed a monitoring device based on SMS sending in order to prevent SA recurrence which will be assessed through a randomized controlled clinical trial

Adolescence et tentative de suicide : devenir, soutien social, facteurs de risque et prévention de la récidive suicidaire

Background: Suicide attempt (SA) concerns 8% to 10% of adolescents and SA recurrence within the year 14% to 20% of adolescents. SA of young patients may have implications over the long term on an academic/professional level, as well as on an affective and psychic level. Objectives: 1) To describe psychosocial outcomes of SAers and the weight of recurrence on these outcomes, 2) to study the impact of losing contact with caregivers during the year following SA, and 3) to study how young SAers use means of communication, and perceive social support they receive and their health-related quality of life. Methods: Three researches were carried out on adolescent SAers. 1) 309 SAers were evaluated at time of SA and 10 years after SA, 2) study of the correlation between a loss of contact with caregivers and SA recurrence occurring between 1 to 10 years after the initial SA of 249 young patients, 3) how 58 SAers use means of communication, and perceive social support they receive and their health-related quality of life. Results: As an adult, the psychosocial situation of young SAers is impaired, especially for those who have a recurrence of SA during the year after index SA. The risk of recurrence increases in the ten years following index SA for early SAers, and in the year following index SA when contact has been lost with caregivers. SAers preferentially use SMS to “keep in touch” with relatives and they assess on a less positive note than peers their social support and health-related quality of life. Perspectives: We developed a monitoring device based on SMS sending in order to prevent SA recurrence which will be assessed through a randomized controlled clinical trial.Contexte : La tentative de suicide (TS) concerne 8 à 10 % des adolescents et la récidive précoce 14 à 20% des adolescents. La TS peut avoir des répercussions à long terme chez les adolescents, tant au niveau scolaire/professionnel, qu’au niveau affectif et psychique. Objectifs : 1) Décrire le devenir psychosocial des suicidants et le poids de la récidive sur ce devenir, 2) étudier l’impact du fait de ne plus être joignable par l’équipe de soins 1 an après la TS et 3) étudier les modalités de communication, le soutien social et la santé perçue des jeunes suicidants. Méthode : 1) 309 sujets ont été inclus avec une évaluation au moment du geste et à 10 ans, 2) étude de l’association du fait de ne plus être joignable par l’équipe de soins avec la récidive suicidaire chez 249 patients, 3) modalité d’utilisation des moyens de communication, perception du soutien social et santé perçue de 58 adolescents suicidants. Résultats : Devenus adultes, les jeunes suicidants ont un devenir psychosocial altéré, d’autant plus lorsqu’ils avaient récidivé durant l’année suivant le geste d’inclusion. Le fait de ne plus être joignable par les soignants un an après la TS d’inclusion majore le risque de récidive suicidaire dans les 10 ans. Chez les suicidants, l’utilisation des SMS est privilégiée pour « rester en lien » avec les proches ; soutien social et santé perçue sont évalués de manière moins positive que chez leurs pairs. Perspectives : Dans un but de prévention de la récidive, nous avons développé un dispositif de veille s’appuyant sur l’envoi de SMS qui sera évalué dans un essai randomisé contrôlé

Devenir psychosocial à 10 ans de 64 adolescents suicidants hospitalisés à l'Hôpital d'enfants de Nancy

Les comportements suicidaires à l'adolescence sont devenus en France un réel problème de Santé Publique depuis plusieurs décennies, en raison de leur importance en nombre mais aussi en raison de leurs conséquences à court et à long terme. Prévenir les récidives suicidaires chez ces jeunes patients, ainsi qu'une évolution psychosociale péjorative est capital. Afin d'adapter au mieux la prise en charge proposée aux adolescents suicidants, il est important de connaître les caractéristiques personnelles, familiales et sociales de ces jeunes patients au moment de leur geste, et surtout l'influence que ces facteurs ont sur les récidives, ainsi que sur le devenir à plus long terme. Ces différentes données sont recherchées et analysées dans cette étude, pour 64 adolescents hospitalisés à l'Hôpital d'Enfants du C.H.U. de Nancy, après une tentative de suicide, en 1996. Des facteurs de risques de tentative de suicide comme les difficultés et le retard scolaires, des facteurs de risque de récidive comme les antécédents psychiatriques personnels, et des facteurs prédictifs d'une évolution psychosociale péjorative à 10 ans comme une situation familiale complexe, ont été objectivés. Tous ces éléments ont ensuite été comparés aux données de la littérature et à celles d'une étude similaire menée en 2004. Cette étude révèle une évolution psychosociale plutôt positive pour les trois quarts des anciens patients suicidants de la population étudiée. Elle vient confirmer l'importance de recevoir le geste suicidaire des adolescents comme le signe d'une souffrance personnelle et la nécessité de prendre en compte les jeunes patients suicidants dans leur globalité, en travaillant de manière individuelle et familiale. Ils ont besoin de soutien et d'aide, afin de pouvoir mettre en mots plutôt que dans l'agir leurs difficultés, et afin de pouvoir rétablir une communication de qualité avec leurs parents. Autant d'éléments qui leur permettront d'appréhender l'avenir dans de meilleures conditions.NANCY1-SCD Medecine (545472101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

MEDIACONNEX: a multicenter randomised trial based on short message service to reduce suicide attempt recurrence in adolescents

International audienceBACKGROUND: Suicide attempt among adolescents is a public health problem around the world. The risk of recurrence is high: about 30 % of adolescents. New ways to prevent suicide attempt recurrence being developed for adult suicide attempters include maintaining contact with them, and results are encouraging.METHODS/DESIGN: The MEDIACONNEX study will be a simple blinded, parallel-group, multicenter randomised controlled trial. It will compare usual care alone to a program based on usual care plus short message service (SMS) provided to adolescents who attempt suicide and who receive treatment in pediatric and adolescent psychiatry units at hospitals in eastern France. Adolescents will be recruited over an 18-month period. The intervention will be based on the SMS, involving personalized and evolving text messages, sent on days 7 to 14 and months 1, 2, 4 and 6 after the SA. The primary endpoint will be the recurrence of an SA, with an assessment during 12 months. Secondary endpoints will be the evolution of 1) social networks, 2) depression and 3) health-related quality of life, with an assessment at inclusion and at 6 months.DISCUSSION: This paper describes the design of MEDIACONNEX, which will assess the effectiveness of an SMS program for adolescent suicide attempters on SA recurrence. This program will be easy to reproduce and inexpensive.TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (no. NCT02762734 ) on March 2016

Short version of the Inventory of Parental Representations, a self-report for attachment assessment among adolescents

Abstract Background  The Inventory of Parental Representations (IPR), a self-administered questionnaire, was developed primarily to identify styles of attachment in adolescence. However, it did not present stable psychometric properties in the various American studies carried out. The aim of this study was to adapt the IPR in French and to provide a shorter version with improved psychometric properties and sound content. Methods The cross-cultural adaptation and content validity were carried out based on qualitative analysis by an Expert Committee and 10 non-clinical adolescents. For the quantitative analyses a cohort of 535 adolescent volunteers was enrolled, corresponding to 1070 responses, and divided into two groups: development and validation. The study of the metric properties of the adapted version of the IPR was realized in the development group, a sample of 275 responses. In case of mediocre results in the Confirmatory Factor Analysis, the development of a new and reduced IPR structure was planned using a mixed method including Classical Test Theory and Rasch Modelling in the development group. Subsequently, the study of the psychometric properties of the short, adapted version was confirmed in an independent sample of 795 responses (validation group). Results Out of 62 items translated, 13 needed adaptations. The analysis of their metric properties produced mediocre results. Content and psychometric property analyses generated two Short version of the IPR in the development group: a paternal scale for Fathers (Short IPRF) with 15 items and a maternal scale for Mothers (Short IPRM) with 16 items. The sound content and good psychometric properties were confirmed in the validation group (Short IPRF: Comparative Fit Index = 0.987, Tucker-Lewis Index = 0.982, Root Mean Square Error of Approximation = 0.027; Short IPRM: Comparative Fit Index = 0.953, Trucker-Lewis Index = 0.927, Root Mean Square Error of Approximation = 0.068). Using Rasch modelling, the attachment was correctly measured overall especially for insecure attachment. Conclusions A step-by-step process involving led to the generation of two questionnaires: a paternal scale, the Short IPRF, and a maternal scale with the Short IPRM providing opportunities to use this self-questionnaire to assess attachment among adolescents. Further work will provide a solid rating for this new tool

Survey evidence of the decline in child abuse in younger Canadian cohorts

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Recurrence of suicide attempt in adolescents lost to contact early by clinicians: The 10-year REPEATERS cohort of French adolescents

International audienceLosing contact with adult suicide attempters in the year after the suicide attempt (SA) increases the risk of recurrence. The situation with adolescents is unknown. We aimed to determine whether being lost to contact early (LCE) by clinicians is a risk factor of long-term SA recurrence among adolescents and the associated factors. Data were collected 10 years after an index SA and a Cox model was used for analysis. Among the 249 SA patients included, 59 (24%) were LCE, the most important risk factor of SA recurrence up to 10 years (hazard ratio [HR] = 2.8 [95% confidence interval (95% CI) 1.4-5.5]; p = .016). Risk factors of being LCE were female sex (odds ratio [OR] = 2.9 [95% CI 1.1-8.2]; p = .009), a psychiatric comorbidity (OR = 2.2 [1.1-4.3]; p = .023) and no family history of suicide (OR = 2.1 [1.1-4.3]; p = .047). These results support the development of preventive actions early after an SA in an adolescent to maintain contact and care

Corrigendum to “Recurrence of suicide attempt in adolescents lost to contact early by clinicians: The 10-year REPEATERS cohort of French adolescents” [Journal of Adolescence 43 (2015) 111–118]

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