The Quest for Meaning Around Self-Injurious and Suicidal Acts: A Qualitative Study Among Adolescent Girls

Introduction: Suicide and non-suicidal self-injury (NSSI) are major problems in adolescent psychiatry and share numerous clinical characteristics. The principal objective of this study is to describe the subjective experience of adolescent girls and young women who present NSSI and/or suicidal behaviors and to determine the common aspects and the specificities of each experience.Method: This exploratory study is based on a procedure that is qualitative, phenomenological, and inductive. The data were collected from two semi-structured interviews each of 18 girls and young women aged 12–21 years, who were receiving care from a psychiatrist specializing in adolescents and who at least once had harmed themselves by NSSI or attempted suicide, or both. The thematic data analysis was performed by applying the methods of interpretative phenomenological analysis.Results: The results are described around four superordinate themes: relationships with the self, with others/otherness, with the body, and with death; they are then subdivided into 13 themes. Several themes appeared common to both types of behavior, especially the relational dimension of self-harming acts. The process of separation-individuation seems complex for these youth.Conclusion: The results underline the relational aspects of the self-harming behavior (NSSI or suicidal) among adolescent girls. These aspects also appear to be expressed in the family sphere, the social sphere, in contact with peers, and also at a societal level when the community no longer addresses adolescents' difficulties. When the process of subjectification does not appear to reach completion, self-aggressive behavior is seen as an ultimate attempt to regain a feeling of autonomy

A Markovian event-based framework for stochastic spiking neural networks

In spiking neural networks, the information is conveyed by the spike times, that depend on the intrinsic dynamics of each neuron, the input they receive and on the connections between neurons. In this article we study the Markovian nature of the sequence of spike times in stochastic neural networks, and in particular the ability to deduce from a spike train the next spike time, and therefore produce a description of the network activity only based on the spike times regardless of the membrane potential process. To study this question in a rigorous manner, we introduce and study an event-based description of networks of noisy integrate-and-fire neurons, i.e. that is based on the computation of the spike times. We show that the firing times of the neurons in the networks constitute a Markov chain, whose transition probability is related to the probability distribution of the interspike interval of the neurons in the network. In the cases where the Markovian model can be developed, the transition probability is explicitly derived in such classical cases of neural networks as the linear integrate-and-fire neuron models with excitatory and inhibitory interactions, for different types of synapses, possibly featuring noisy synaptic integration, transmission delays and absolute and relative refractory period. This covers most of the cases that have been investigated in the event-based description of spiking deterministic neural networks

Metasynthesis : a qualitative evidence synthesis method implemented into adolescent mental care

La méthode qualitative est en plein essor en médecine et particulièrement en psychiatrie, où la place du sujet, et ses représentations de la maladie et du soin sont centrales dans la prise en charge. Dans le champ de la santé de l'adolescent, de grands travaux permettent des avancées importantes dans la compréhension de la souffrance et les propositions de soins. Les méthodes qualitatives sont pourtant souvent critiquées de par leur contextualité et leur manque de pouvoir de généralisation. Une façon d'améliorer ces deux aspects consiste à appareiller les études traitant la même problématique de manière à en synthétiser les principaux résultats. Cet exercice de synthèse, notablement différent de celui de méta-analyse propre à la recherche quantitative, est réalisé depuis longtemps dans le champ des sciences humaines. Il s'agit de la métasynthèse, ou meta-ethnography. L'exercice de synthèse de la littérature est aujourd'hui de plus en plus codifié en recherche scientifique. Pourtant, certains points sont toujours en discussion - critères d'inclusion des études, critères de qualité des études-. De plus, aucune équipe psychiatrique ne s'est approprié l'outil de la métasynthèse pour l'adapter à la discipline. Ce travail décrit les étapes de la construction et de l'adaptation, à partir du corpus existant, d'une méthode rigoureuse, effective, simple à transposer et enseigner, permettant la métasynthèse de données de la littérature dans le domaine du soin psychique de l'adolescent. Il s'agit d'une part d'une réflexion théorique, épistémologique et méthodologique sur les métasynthèses et leur adaptation au champ de la clinique psychiatrique. Il s'agit d'autre part d'une construction pratique, réalisée à partir de métasynthèses effectuées sur des thématiques du soin psychique de l'adolescent. Les deux premiers articles sont deux travaux de métasynthèse. Le premier concerne l'obésité de l'adolescent. Les résultats obtenus mettent en lumière les limites de la méthode utilisée. Le deuxième article s'intéresse à la question des comportements suicidaires à l'adolescence. Les enseignements méthodologiques du premier article ont permis de perfectionner la méthode de métasynthèse. Enfin, le troisième article propose une description détaillée des étapes de la méthode construite. En discussion, nous proposons de resituer la méthode de la métasynthèse dans le contexte historique du niveau de preuve scientifique. Nous illustrons avec les articles les plus récents les liens toujours plus forts qui se construisent entre la méthode de la métasynthèse, aujourd'hui appelée Qualitative Evidence Synthesis, et la médecine fondée sur les preuves. La métasynthèse est une méthode moderne, qui montre tout son intérêt dans la recherche médicale. Notre méthode appliquée à la psychiatrie de l'adolescent est rigoureuse et fiable, et permet d'accroître la connaissance scientifique et d'améliorer la prise en charge des patients.Qualitative research is expanding fast in medicine and especially in psychiatry, where the patient and his representations of illness and care are central to treatment. In the field of adolescent health, great work provides important advances in the understanding of suffering and care. Qualitative methods are however often criticized because of their contextuality and their lack of generalization power. One way to improve these aspects is to match studies addressing the same issue so as to synthesize the main results. From a long time, human sciences have taken hold of this exercise of synthesis, which is significantly different from meta-analysis of quantitative research. They have called this work metasynthesis or meta-ethnography. The literature synthesis exercise is now increasingly codified in scientific research. However, some points are still under discussion - For example, inclusion criteria for studies, study quality criteria -. Moreover, no metasynthesis exist in the field of psychiatric research. This work describes the stages of construction and adaptation of a simple, rigorous, efficient, easy to share and teach method, which enables to do qualitative data synthesis in the field of psychological care to adolescents. On the one hand, we propose a theoretical, epistemological and methodological reflection on metasyntheses and their adaptation to the field of psychiatric care. On the other hand, we describe a practical progression: our method is built from metasyntheses conducted on two themes of adolescent psychological care. The first two papers are both metasyntheses. The first one is about adolescent obesity. The results highlight the limitations of the method we used. The second article focuses on the issue of suicidal behavior in adolescence. The methodological lessons of the first article helped us to improve the meta-synthesis method. The third article provides a detailed description of each steps of the method. In discussion, we propose to situate the method of metasynthesis in the historical context of the scientific evidence. We illustrate with recent papers the increasingly strong links that exist between metasynthesis, now called Qualitative Evidence Synthesis, and Evidence-Based Medicine. The metasynthesis is a modern method. It shows its interest in medical research. Our method applied to adolescent psychiatry is rigorous and reliable, and can increase scientific knowledge and improve the care of patients

La métasynthèse : une méthode de synthèse des données qualitatives appliquée aux soins psychiques de l'adolescent

Qualitative research is expanding fast in medicine and especially in psychiatry, where the patient and his representations of illness and care are central to treatment. In the field of adolescent health, great work provides important advances in the understanding of suffering and care. Qualitative methods are however often criticized because of their contextuality and their lack of generalization power. One way to improve these aspects is to match studies addressing the same issue so as to synthesize the main results. From a long time, human sciences have taken hold of this exercise of synthesis, which is significantly different from meta-analysis of quantitative research. They have called this work metasynthesis or meta-ethnography. The literature synthesis exercise is now increasingly codified in scientific research. However, some points are still under discussion - For example, inclusion criteria for studies, study quality criteria -. Moreover, no metasynthesis exist in the field of psychiatric research. This work describes the stages of construction and adaptation of a simple, rigorous, efficient, easy to share and teach method, which enables to do qualitative data synthesis in the field of psychological care to adolescents. On the one hand, we propose a theoretical, epistemological and methodological reflection on metasyntheses and their adaptation to the field of psychiatric care. On the other hand, we describe a practical progression: our method is built from metasyntheses conducted on two themes of adolescent psychological care. The first two papers are both metasyntheses. The first one is about adolescent obesity. The results highlight the limitations of the method we used. The second article focuses on the issue of suicidal behavior in adolescence. The methodological lessons of the first article helped us to improve the meta-synthesis method. The third article provides a detailed description of each steps of the method. In discussion, we propose to situate the method of metasynthesis in the historical context of the scientific evidence. We illustrate with recent papers the increasingly strong links that exist between metasynthesis, now called Qualitative Evidence Synthesis, and Evidence-Based Medicine. The metasynthesis is a modern method. It shows its interest in medical research. Our method applied to adolescent psychiatry is rigorous and reliable, and can increase scientific knowledge and improve the care of patients.La méthode qualitative est en plein essor en médecine et particulièrement en psychiatrie, où la place du sujet, et ses représentations de la maladie et du soin sont centrales dans la prise en charge. Dans le champ de la santé de l'adolescent, de grands travaux permettent des avancées importantes dans la compréhension de la souffrance et les propositions de soins. Les méthodes qualitatives sont pourtant souvent critiquées de par leur contextualité et leur manque de pouvoir de généralisation. Une façon d'améliorer ces deux aspects consiste à appareiller les études traitant la même problématique de manière à en synthétiser les principaux résultats. Cet exercice de synthèse, notablement différent de celui de méta-analyse propre à la recherche quantitative, est réalisé depuis longtemps dans le champ des sciences humaines. Il s'agit de la métasynthèse, ou meta-ethnography. L'exercice de synthèse de la littérature est aujourd'hui de plus en plus codifié en recherche scientifique. Pourtant, certains points sont toujours en discussion - critères d'inclusion des études, critères de qualité des études-. De plus, aucune équipe psychiatrique ne s'est approprié l'outil de la métasynthèse pour l'adapter à la discipline. Ce travail décrit les étapes de la construction et de l'adaptation, à partir du corpus existant, d'une méthode rigoureuse, effective, simple à transposer et enseigner, permettant la métasynthèse de données de la littérature dans le domaine du soin psychique de l'adolescent. Il s'agit d'une part d'une réflexion théorique, épistémologique et méthodologique sur les métasynthèses et leur adaptation au champ de la clinique psychiatrique. Il s'agit d'autre part d'une construction pratique, réalisée à partir de métasynthèses effectuées sur des thématiques du soin psychique de l'adolescent. Les deux premiers articles sont deux travaux de métasynthèse. Le premier concerne l'obésité de l'adolescent. Les résultats obtenus mettent en lumière les limites de la méthode utilisée. Le deuxième article s'intéresse à la question des comportements suicidaires à l'adolescence. Les enseignements méthodologiques du premier article ont permis de perfectionner la méthode de métasynthèse. Enfin, le troisième article propose une description détaillée des étapes de la méthode construite. En discussion, nous proposons de resituer la méthode de la métasynthèse dans le contexte historique du niveau de preuve scientifique. Nous illustrons avec les articles les plus récents les liens toujours plus forts qui se construisent entre la méthode de la métasynthèse, aujourd'hui appelée Qualitative Evidence Synthesis, et la médecine fondée sur les preuves. La métasynthèse est une méthode moderne, qui montre tout son intérêt dans la recherche médicale. Notre méthode appliquée à la psychiatrie de l'adolescent est rigoureuse et fiable, et permet d'accroître la connaissance scientifique et d'améliorer la prise en charge des patients

Le dispositif à médiations thérapeutiques dans la clinique de l'agir adolescent

International audienceThe pathologies of the adolescent act illustrate the overflow so characteristic of the “modernity” of a world in perpetual evolution. Through compulsive bodily symptoms that are as noisy as they are enigmatic (self-mutilation, suicide attempts, addictions, fast sex, eating disorders), adolescents are always in search of transitional and containing spaces, which are indispensable for symbolizing and calming destructuring intrapsychic conflicts. Therapeutic mediations, adapted to the different singularities, offer a space through which integration and subjectivation processes are possible

Photographier pour avancer, l'utilisation de la photographie en psychothérapie

International audienceThe practice of the clinical psychologist in child psychiatry can be a perilous task. His balance, as precarious as it may be, lies in listening to and observing the patient, but also in the use of precious tools of which therapeutic mediations are a part. They allow to experiment a sensory-motor anchorage and bring a multidimensional vision necessary to the comprehension of the subject and his suffering. By creating an intermediary space between the I and the You, the outside and the inside, they determine a place where the psychotherapeutic work can take place

Quand les mots manquent, le corps signifie (apports de la recherche qualitative à la compréhension du rôle de la nourriture chez l'adolescent obèse et sa famille)

L'obésité de l'enfant et de l'adolescent est un enjeu majeur de santé publique en France et dans le monde, de par sa prévalence et son retentissement sévère. Les relations familiales y occupent une place importante, dans la genèse du trouble, son maintien, et sa prise en charge. La famille est au cœur du dispositif thérapeutique. Pourtant, le lien entre le fonctionnement relationnel familial et la nourriture n'est pas clairement établi sur le plan théorique. L'objectif de ce travail est de poser les bases d'une élaboration théorique de cette question. Pour ceci, nous avons utilisé des méthodes qualitatives de deux manières. La 1ère partie a consisté en une étude qualitative phénoménologique du rôle de l'alimentation dans les relations familiales chez ces adolescents obèses. Deux entretiens semi-structurés (adolescents, parents) se déroulaient autour d'une photographie de la fin d'un repas prise par le sujet (méthode de la photo-elicitation). L'analyse du matériel verbal utilisait l'Interpretative Phenomenological Analysis (IPA). La 2ème partie a consisté en une revue de la littérature qualitative sur l'obésité de l'adolescent, à l'aide d'une méthode d'analyse d'inspiration phénoménologique. Les articles inclus interrogeaient les adolescents obèses, leurs parents ou les spécialistes de santé travaillant auprès de jeunes souffrant d'obésité. Les principaux résultats sont d'une part, la mise en évidence d'interelations majeures entre relations et nourriture au sein de la famille ; le fonctionnement alimentaire apparait comme le reflet du fonctionnement relationnel ; d'autre part, la mise en évidence d'une impossibilité à dire obésité, qui semble le témoin d'une impossibilité à utiliser la parole signifiante dans la relation familiale. L'hypothèse retenue serait celle d'un trouble de la sphère relationnelle, où le passage par les mots est compromis. L'alimentation deviendrait alors le principal moyen de communication et d'expression au sein de la famille.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

Metasynthesis: An Original Method to Synthesize Qualitative Literature in Psychiatry

BackgroundMetasynthesis—the systematic review and integration of findings from qualitative studies—is an emerging technique in medical research that can use many different methods. Nevertheless, the method must be appropriate to the specific scientific field in which it is used. The objective is to describe the steps of a metasynthesis method adapted from Thematic Synthesis and phenomenology to fit the particularities of psychiatric research.MethodWe detail each step of the method used in a metasynthesis published in 2015 on adolescent and young adults suicidal behaviors. We provide clarifications in several methodological points using the latest literature on metasyntheses. The method is described in six steps: define the research question and the inclusion criteria, select the studies, assess their quality, extract and present the formal data, analyze the data, and express the synthesis.ConclusionMetasyntheses offer an appropriate balance between an objective framework, a rigorously scientific approach to data analysis and the necessary contribution of the researcher’s subjectivity in the construction of the final work. They propose a third level of comprehension and interpretation that brings original insights, improve the global understanding in psychiatry, and propose immediate therapeutic implications. They should be included in the psychiatric common research toolkit to become better recognized by clinicians and mental health professionals

Étude qualitative de l'expérience de la formation en hypnose clinique pour les professionnels de santé

International audienceObjective: Training in clinical hypnosis leads to important transformations in healthcare professionals, in their professional practices as well as in their personal lives. The objective of this study was to explore how health professionals experience the transformations that result from such a training. Method: Semi-structured interviews with health professionals from France and Europe were conducted. The qualitative method used was Interpretative Phenomenological Analysis. Purposive sampling required to include participants from different professions, experience and regions of origin. They had already completed training in clinical hypnosis at different teaching institutions. Results: Ten participants were included. The analysis showed four meta-themes of experience. First, it revealed participants’ motivations for training in clinical hypnosis as one's desire to improve one's practice, leading to extraordinary discoveries, at a particular timing in their life. Second, participants described that hypnosis sometimes set the ground for a relationship verging on the more “intimate”, therefore requiring greater caution so as not to disrupt the patient/healthcare professional relationship. Third, some participants experienced unforeseen personal fulfilment, better self-regulation of emotions and improved quality of life as well as greater comfort at the workplace. Finally, this study shed light on two limitations of training in clinical hypnosis as it can sometimes generate stress for the participants and/or result in bring about potential harmful effects: one of the risks being that the trainer might cross some ethical lines. Discussion: The level of personal change experienced by the participants is similar to some changes induced by personal psychotherapy. For several participants, issues of power and vulnerability in the relationship using hypnosis were associated with a feeling of instability during the training. In hypnosis, the management of an asymmetrical relationship involves a two-way risk: vulnerability of the hypnotized person to the all-powerful relationship of their therapist as well as destabilization of therapists by the reduction of power asymmetry during hypnotic work with their patients

Obesity and interoceptive awareness: A preliminary qualitative study of hospitalized adolescent girls with obesity

International audienceObjectives: Childhood obesity has increased tenfold over the past 40 years. People with obesity present alterations of their bodily perceptions and a discrepancy between their actual body and their perceived body. One of the explanations advanced by neuroscience is the difficulty of integrating and processing sensory information, particularly the interoceptive interformation. There has been little research on this question in adolescent populations, although it is suggested that an atypical interoceptive mechanism is positively associated with the onset of psychopathologies and decreased socio-emotional skills in adulthood. We present here the first results of a qualitative research study that explores the experiential dimension of interception by obese adolescent girls in a hospitalization context and that assesses the main factors that influence interoceptive self-awareness: anxiety and pain. Method: Exploratory qualitative research. T0 (30 min): Initial assessments: State trait anxiety Inventory for Children (STAIC Scale), visual analog scale for pain and Multidimensional Assessment of Interoceptive Awareness (MAIA Self-Questionnaire). T1 and T2 (60 min): perform three simple poses, each 1 min (T1) alternated with an explanatory interview exploring the interoceptive experience (T2). Results: This study highlights that: (i) the severity of obesity is not positively associated with the level of interoceptive awareness; (ii) the correlation of influencing factors (pain and anxiety) and the level of awareness interoceptive is weak; (iii) the thematic categorization according to Mehling's eight interoceptive criteria demonstrates, for the participants: 1/the ability to identify their bodily perceptions by the majority of them; 2/the uneven capacity to maintain a level of attention on the body in its ensemble; 3/the ability not to worry about feelings of discomfort is influenced by hyper-rationalization or the negation of perceptions; 4/breathing appears to be the most mobilized lever to regulate attention; 5/the links between bodily perceptions and felt emotions are influenced by rationalization, bodily experience, or mood decline; 6/self-regulation is influenced by bodily experience, which enables awareness and postural readjustment; 7/listening to the body is influenced by the transfer of past bodily practices; 8/the notion of confidence in one's bodily perceptions is not always well understood and is not related to subjects’ ability to identify their internal manifestations, while perceived confidence is related to the level of rationalization and can be improved through postural practice. Discussion: As reported in the literature, the interoceptive level of patients interviewed is generally low on the rating scales, but it appears that the MAIA results do not always reveal the perceived reality of body-self of the adolescent girls interviewed; guiding the participants in explaining their bodily experience reveals a much greater interoceptive dimension. We qualify this guided field of exploration as an interoceptive proximal zone or an interoceptive preconception zone. Conclusion: We suggest that a better understanding of the interoceptive mechanisms experienced by obese people helps guide patients towards a safer experiential dimension of their body. Future research should enrich this qualitative perspective of interoception and open up more embodied dimensions of care