How physicians caring for adult patients presenting a chronic mental disturbance take account of the difficulties their patients’ children under 18: Preliminary study

AbstractAimsTo study how physicians caring for adult patients presenting a chronic mental disturbance take account of the difficulties of their patients’ children under 18.MethodExploratory and qualitative study based on an in-depth study of interviews.Study populationThirteen physiatrists or neurologists following brain-damaged patients and 12 psychiatrists following patients with chronic psychiatric disorders.ResultsIn the two groups of physicians, diversified practices in catering for the issues of the patient's parenthood, child–parent relationships, and difficulties experienced by the child. The child's difficulties are not approached as such. For many of the physicians, representations of the parenting function, and of the child's needs and difficulties are not often used in work with the patient. Patient-centred care appears at odds with catering for the patient's children and their specific difficulties. The seriousness of the mental pathologies, their chronic nature, and the fact that they can affect the patient in his/her parental functioning and concerns, appear as factors in the reluctance of physicians. Other reasons are lack of familiarity with issues relating to childhood, and the feeling of encroaching on a private and intimate sphere. The representations of physicians with regard to parenthood, parent–child relations, and the needs and difficulties of children, are often not integrated into the corpus of knowledge. These issues are more often aspects of physicians’ own experience.ConclusionThe conflict of values and the uneasiness of the physicians suggest the need for ethical reflection groups or Balint groups

Psychotropic medication in the French child and adolescent population: prevalence estimation from health insurance data and national self-report survey data

International audienceBACKGROUND: The aim of this work is to estimate the French frequencies of dispensed psychotropic prescriptions in children and adolescents. Prevalence estimations of dispensed prescriptions are compared to the frequencies of use of psychotropic reported by 17 year-old adolescents. METHODS: Prescription data is derived from national health insurance databases. Frequencies of dispensed prescriptions are extrapolated to estimate a range for the 2004 national rates. Self-report data is derived from the 2003 and 2005 ESCAPAD study, an epidemiological study based on a questionnaire focused on health and drug consumption. RESULTS: The prevalence estimation shows that the prevalence of prescription of a psychotropic medication to young persons between 3 and 18 years is about 2.2%.In 2005, the self-report study (ESCAPAD) shows that 14.9% of 17 year-old adolescents took medication for "nerves" or "to sleep" during the previous 12 months. The same study in 2003 also shows that 62.3% of adolescents aged 17 and 18 reporting psychotropic use, took the medication for anxiety and 56.8% to sleep. Only 49.7% of these medications are suggested by a doctor. CONCLUSION: This study underlines a similar range of prevalence of psychotropic prescriptions in France to that observed in other European countries. Nevertheless, the proportion of antipsychotics and benzodiazepines seems to be higher, whereas the proportion of methylphenidate is lower.Secondly, a disparity between the prevalence of dispensed prescriptions and the self-report of actual use of psychotropics has been highlighted by the ESCAPAD study which shows that these treatments are widely used as "self-medication"

Psychodynamic Experience Enhances Recognition of Hidden Childhood Trauma

BACKGROUND: Experimental psychology has only recently provided supporting evidence for Freud's and Janet's description of unconscious phenomena. Here, we aimed to assess whether specific abilities, such as personal psychodynamic experience, enhance the ability to recognize unconscious phenomena in peers - in other words, to better detect implicit knowledge related to individual self-experience. METHODOLOGY AND PRINCIPAL FINDINGS: First, we collected 14 videos from seven healthy adults who had experienced a sibling's cancer during childhood and seven matched controls. Subjects and controls were asked to give a 5-minute spontaneous free-associating speech following specific instructions created in order to activate a buffer zone between fantasy and reality. Then, 18 raters (three psychoanalysts, six medical students, three oncologists, three cognitive behavioral therapists and three individuals with the same experience of trauma) were randomly shown the videos and asked to blindly classify them according to whether the speaker had a sibling with cancer using a Likert scale. Using a permutation test, we found a significant association between group and recognition score (ANOVA: p = .0006). Psychoanalysts were able to recognize, above chance levels, healthy adults who had experienced sibling cancer during childhood without explicit knowledge of this history (Power = 88%; p = .002). In contrast, medical students, oncologists, cognitive behavioral therapists and individuals who had the same history of a sibling's cancer were unable to do so. CONCLUSION: This experiment supports the view that implicit recognition of a subject's history depends on the rater's specific abilities. In the case of subjects who did have a sibling with cancer during childhood, psychoanalysts appear better able to recognize this particular history

Maternal depression symptoms and internalising problems in the offspring: the role of maternal and family factors

Maternal depression symptoms (MDS) are a robust risk factor for internalising problems (IP) in the offspring. However, the relative importance of MDS and other factors associated with it (i.e. other types of maternal psychopathology, maternal parenting practices, family characteristics) is not well understood. To (a) identify a group of children with high levels of IP between 6 and 12 years using combined maternal and teacher assessments and (b) to quantify the associations between trajectories of MDS during early childhood and children's IP trajectories before and after controlling for family factors associated with MDS. MDS and family factors were assessed in a population-based sample in Canada (n = 1537) between 5 months and 5 years. The outcome variable was membership in trajectories of teacher- and mother-rated IP between ages 6 and 12 years. Family factors were included as covariates in a multinomial logistic regression model. There was a strong association between MDS and children's atypically high levels of IP in unadjusted analyses [OR 4.14 (95% CI 2.60; 6.61)]. The association was reduced, but remained strong [2.60 (1.55; 4.36)] when maternal psychopathology, maternal parenting, and family socioeconomic status were entered in the model. MDS, maternal anxiety, and low parental self-efficacy were associated with offspring's high IP trajectories. MDS is associated with high levels of children's IP independently of other maternal and family characteristics. Intervention targeting maternal psychopathology and parenting self-efficacy and testing the impact on children's IP would provide information on the putative causal pathways between maternal and offspring's symptomatology

Psychodynamic Experience Enhances Recognition of Hidden Childhood Trauma

BACKGROUND: Experimental psychology has only recently provided supporting evidence for Freud's and Janet's description of unconscious phenomena. Here, we aimed to assess whether specific abilities, such as personal psychodynamic experience, enhance the ability to recognize unconscious phenomena in peers - in other words, to better detect implicit knowledge related to individual self-experience. METHODOLOGY AND PRINCIPAL FINDINGS: First, we collected 14 videos from seven healthy adults who had experienced a sibling's cancer during childhood and seven matched controls. Subjects and controls were asked to give a 5-minute spontaneous free-associating speech following specific instructions created in order to activate a buffer zone between fantasy and reality. Then, 18 raters (three psychoanalysts, six medical students, three oncologists, three cognitive behavioral therapists and three individuals with the same experience of trauma) were randomly shown the videos and asked to blindly classify them according to whether the speaker had a sibling with cancer using a Likert scale. Using a permutation test, we found a significant association between group and recognition score (ANOVA: p = .0006). Psychoanalysts were able to recognize, above chance levels, healthy adults who had experienced sibling cancer during childhood without explicit knowledge of this history (Power = 88%; p = .002). In contrast, medical students, oncologists, cognitive behavioral therapists and individuals who had the same history of a sibling's cancer were unable to do so. CONCLUSION: This experiment supports the view that implicit recognition of a subject's history depends on the rater's specific abilities. In the case of subjects who did have a sibling with cancer during childhood, psychoanalysts appear better able to recognize this particular history

J Med Internet Res

Background: Immune checkpoint inhibitors (ICIs) are increasingly used to treat several types of tumors. Impact of this emerging therapy on patients’ health-related quality of life (HRQoL) is usually collected in clinical trials through standard questionnaires. However, this might not fully reflect HRQoL of patients under real-world conditions. In parallel, users’ narratives from social media represent a potential new source of research concerning HRQoL. Objective: The aim of this study is to assess and compare coverage of ICI-treated patients’ HRQoL domains and subdomains in standard questionnaires from clinical trials and in real-world setting from social media posts. Methods: A retrospective study was carried out by collecting social media posts in French language written by internet users mentioning their experiences with ICIs between January 2011 and August 2018. Automatic and manual extractions were implemented to create a corpus where domains and subdomains of HRQoL were classified. These annotations were compared with domains covered by 2 standard HRQoL questionnaires, the EORTC QLQ-C30 and the FACT-G. Results: We identified 150 users who described their own experience with ICI (89/150, 59.3%) or that of their relative (61/150, 40.7%), with 137 users (91.3%) reporting at least one HRQoL domain in their social media posts. A total of 8 domains and 42 subdomains of HRQoL were identified: Global health (1 subdomain; 115 patients), Symptoms (13; 76), Emotional state (10; 49), Role (7; 22), Physical activity (4; 13), Professional situation (3; 9), Cognitive state (2; 2), and Social state (2; 2). The QLQ-C30 showed a wider global coverage of social media HRQoL subdomains than the FACT-G, 45% (19/42) and 29% (12/42), respectively. For both QLQ-C30 and FACT-G questionnaires, coverage rates were particularly suboptimal for Symptoms (68/123, 55.3% and 72/123, 58.5%, respectively), Emotional state (7/49, 14% and 24/49, 49%, respectively), and Role (17/22, 77% and 15/22, 68%, respectively). Conclusions: Many patients with cancer are using social media to share their experiences with immunotherapy. Collecting and analyzing their spontaneous narratives are helpful to capture and understand their HRQoL in real-world setting. New measures of HRQoL are needed to provide more in-depth evaluation of Symptoms, Emotional state, and Role among patients with cancer treated with immunotherapy