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Resume La pratique de la medecine fœtale permet le depistage d’anomalies fœtales in utero. Ces diagnostics entrainent une veritable effraction dans le psychisme maternel et les emotions maternelles sont alors intenses. La decouverte d’une anormalite chez le fœtus enclenche une prise en charge dans un Centre plurisiciplinaire de diagnostic prenatal (CPDPN) et la femme pourra envisager une Interruption medicale de grossesse (IMG) devant la particuliere gravite de la pathologie fœtale, si elle le souhaite, apres accord du CPDPN. Mais comment peut-elle prendre une telle decision en pleine tempete emotionnelle, suite a l’annonce de cette anomalie fœtale ? Comment mobilise-t-elle ses emotions, notamment negatives, dans ce processus decisionnel transgressif de l’IMG ? Il est donc necessaire, dans un premier temps, de contextualiser notre etude par les apports theoriques sur la medecine fœtale, la particularite psychique de la grossesse et sur les emotions presentes lors de l’annonce d’une malformation fœtale. Dans un second temps, afin de mieux connaitre le vecu emotionnel, une etude des temoignages maternels a ete effectuee pour pouvoir analyser le role des emotions dans cette prise de decision d’IMG. Enfin, une discussion autour des resultats de cette etude abordera la necessite de ces emotions dans ce processus decisionnel et l’interet de les valoriser par les equipes des CPDPN afin de les rationnaliser en vue d’un meilleur vecu pour ces femmes.

Purpose. Anorexia Nervosa (AN) is a severe chronic disorder and parents’ experience of caregiving is usually marked by emotional distress and burden. Severe chronic psychiatric disorders are known to be linked with the concept of grief. Grief has not been investigated in AN. The aim of this study was to examine parents’ and adolescents’ characteristics that underlie parental burden and grief in AN, and the link between these two dimensions. Methods. Eighty mothers, 55 fathers and their adolescents (N=84) hospitalized for AN participated in this study. Evaluations of clinical characteristics of the adolescent’s illness were completed, as well as self-evaluations of adolescent and parental emotional distress (anxiety, depression, alexithymia). Levels of parental burden were evaluated with the Experience Caregiving Inventory and levels of parental grief with the Mental Illness Version of the Texas Revised Inventory of Grief.Results. Main findings indicated that burden was higher in parents of adolescents with a more severe AN; fathers’ burden was also significantly and positively related to their own level of anxiety. Parental grief was higher when adolescents’ clinical state was more severe. Paternal grief was related to higher anxiety and depression, while in mothers, grief was correlated to higher alexithymia and depression. Paternal burden was explained by father’s anxiety and grief, and maternal burden by mother’s grief and her child’s clinical state.Conclusion. Parents of adolescents suffering from AN experienced high levels of burden, emotional distress and grief. These perceptions (that are also inter-related) should be specific targets for intervention aimed at supporting parents. Our results sustained the extensive literature on the need to assist fathers and mothers in their caregiving role. This in turn may improve both their mental health and their abilities as caregivers of their suffering child.ClinicalTrials.gov Identifier: NCT00910169grief; burden; caregiving; parents; anorexia nervosa; gender roleLevel of evidence III

Eating disorders (EDs) are common conditions that mainly affect women of reproductive age and have a major impact on fertility. Our systematic review focuses on the prevalence of EDs in patients in the process of assisted reproductive technique (ART) and describes the phenotypes of EDs identified.Our systematic review is based on the PRISMA criteria. Articles were collected using the Medline/Pubmed, Web Of Science and Cochrane databases. The articles chosen had to mention the prevalence of ED in infertile patients undergoing ART and be cohort or case-control studies assessing the prevalence of ED during fertility treatment.Fifteen articles were included in this review. The prevalence of active ED varied between 0.13 and 44% depending on the types considered in each study. The main phenotypes described were EDNOS (eating disorder not otherwise specified) and binge eating disorders (BED) occurring in women with a normal body mass index (BMI) and a history of ED. Mainly subthreshold forms with cognitive distortions were described.This review highlights a 6 times higher prevalence of EDs in infertile patients undergoing fertility treatment compared to regular pregnant women. However, diagnosing these conditions is complex. As a result, it is essential that professionals in contact with this population are alert to symptoms consistent with these conditions in order to refer them to specialized psychiatric care.RéSUMé: INTRODUCTION: les troubles des conduites alimentaires (TCA) sont des pathologies fréquentes affectant principalement les femmes en âge de procréer avec un impact majeur sur la fertilité. Notre revue de la littérature s’intéresse à la prévalence du trouble chez les sujets inscrits dans un processus d’assistance médicale à la procréation (AMP) et décrit les phénotypes des TCA repérés. MéTHODE: notre revue de la littérature se base sur les critères PRISMA. Les articles ont été collectés en utilisant les bases de données Medline/Pubmed, Web Of Science et Cochrane. Les articles sélectionnés devaient faire état de la prévalence des TCA chez les sujets infertiles recourant à une AMP, être des études de cohorte ou cas-témoins évaluant la prévalence des TCA au cours d’une AMP. RéSULTATS: quinze articles ont été inclus dans cette revue. Les prévalences de TCA actifs variaient entre 0,13 et 44% en fonction des formes considérées. Les principaux phénotypes décrits étaient les formes non spécifiques (EDNOS) et hyperphagiques (BED) survenant chez des femmes avec un indice de masse corporel (IMC) normal et présentant des antécédents de TCA. Il était décrit des formes subsyndromiques prédominées par des distorsions cognitives. CONCLUSION: cette revue met en évidence une prévalence de TCA supérieure chez les sujets infertiles recourant à une AMP par rapport aux femmes enceintes en population générales. Leur diagnostic est cependant complexe. Il est donc capital que les professionnels au contact de cette population soient vigilants aux symptômes évocateurs afin d’orienter vers une prise en charge spécialisée.Eating disorders are frequent pathologies that primarily affect women of childbearing age. Numerous articles reveal an increased risk for the mother and the child in case of an active disorder during pregnancy.We conducted a systematic review to determine the prevalence and phenotypes of eating disorders in infertile subjects undergoing fertility treatment.The results of the fifteen articles included show a prevalence six times higher than in pregnant women in the general population. Subjects with eating disorders have normal body mass indexes. The active forms are mainly characterized by episodes of binge eating disorders or other unspecified forms. Studies also describe incomplete forms characterized by the presence of dysfunctional thoughts around shape and weight without associated compensatory behavior.Professionals working in the field of reproductive medicine and providing fertility treatment have a major role to play in identifying and referring these subjects at risk to specialized care.

To test if the evaluation of body dissatisfaction by images could be an interesting tool to detect perinatal depression early in pregnancy, questioning patients about their body image instead of their depressive symptoms.A sample of 457 women was recruited in a longitudinal study. Three evaluations were performed at the 4th and 8th months of pregnancy and during post-partum. During these evaluations, sociodemographic data were collected and psychiatric scales were completed, including Edinburgh Postnatal Depression Scale (EPDS), Eating Disorder Examination-Questionnaire (EDE-Q), Pictorial Body Image Scale (PBIS) and Body Shape Questionnaire (BSQ).33% of the women who were unsatisfied with their body image suffered from perinatal depression vs. 11.3% of the women who were not (p 0.0001). The risk of perinatal depression was 4 times higher in women dissatisfied with their body image (p 0.001) if unintended pregnancy and age are taken into account and is 3 times significantly higher in women with higher levels of eating disorders symptoms (p 0.001) if unintended pregnancy and age are taken into account. Our sample was a privileged population, as often in the literature.The administration of a simple scale (PBIS) during an early visit during pregnancy allows detecting perinatal depression. This should prevent the stigmatization of women during pregnancy and reduce the risk of not diagnosing depression during pregnancy and post-partum.

Patients with autoimmune encephalitis (AE) are likely to exhibit an acute onset of severe psychiatric features, including psychosis and/or catatonia. Based on the high prevalence of catatonia in AE and our clinical experience, we hypothesized that catatonia might be a marker of severity requiring more aggressive treatment approaches.To reach a sufficient number of cases with brain-autoimmune conditions, we pooled two samples (N = 58): the first from the French National Network of Rare Psychiatric diseases and the second from the largest Italian neuro-pediatrics center for encephalopathies. Autoimmune conditions were diagnosed using a multidisciplinary approach and numerous paraclinical investigations. We retrospectively compared patients with and without catatonia for psychiatric and non-psychiatric clinical features, biological and imaging assessments, type of immunotherapy used and outcomes.The sample included 25 patients (43%) with catatonia and 33 (57%) without catatonia. Forty-two patients (72.4%) had a definite AE (including 27 anti-NMDA receptor encephalitis) and 16 (27.6%) suspected autoimmune encephalitis. Patients with catatonia showed significantly more psychotic features [18 (72%) vs 9 (27.3%), p 0.001)] and more movement disorders [25 (100%) vs 20 (60.6%), p 0.001] than patients without catatonia. First line (corticoids, immunoglobulin and plasma exchanges) and second line (e.g., rituximab) therapies were more effective in patients with catatonia, with 24 (96%) vs 22 (66.7%) (p = 0.006) and 17 (68%) vs 9 (27.3%) (p = 0.002), respectively. However, those with catatonia received more combinations of first and second line treatments and had more relapses during outcomes.Despite its exploratory design, the study supports the idea that autoimmune catatonia may be a marker of severity and morbidity in terms of initial presentation and relapses, requiring the need for early and aggressive treatment.

The requesting of medical termination of pregnancy (MTP) for psychosocial reasons invites several questions concerning progress in medicine as well raising necessary and legitimate ethical questions. The law currently permits MTP for maternal reasons at any stage of pregnancy if the woman's health is at a significant risk. However, conceptions of mental health risks remain a grey area and present difficulties in terms of psychiatric assessment. When dealing with a patient suffering from a psychiatric disorder, questions must be asked on the reasons behind the request as well as questions concerning free and clear consent. It must also be taken into account that the progressive nature of pregnancy means patient care must be provided relatively quickly. These cases invite discussion on medical decisions, on both a moral and rational level, and the legitimacy of the basis on which the medical decision is taken in the context of MTP for psychosocial reasons.

Objectives Pediatric catatonia is a rare and life-threatening syndrome. Around 20% of juvenile catatonia is associated with organic condition (Consoli et al., 2012). Autoimmune conditions represent a diagnostic and therapeutic challenge since specific antibodies can be missed. To facilitate decision making, we recently formulated a causality assessment score (CAUS) using a stepwise approach and an immunosuppressive therapeutic challenge (Ferrafiat et al., 2016). Our objectives were to validate retrospectively CAUS and to define its threshold for an accurate distinction between organic catatonia and non-organic catatonia, and specifically between autoimmune catatonia and non-organic catatonia. Method To obtain a sufficient number of cases with organic catatonia, we pooled two samples ( N = 104) – one from a child psychiatry center, the other from neuro-pediatrics center – expert in catatonia and autoimmune conditions. Organic conditions were diagnosed using a multidisciplinary approach and numerous paraclinical investigations. Given the binary classification needs, we used receiver operating characteristic (ROC) analysis (Peacock and Peacock, 2010) to calculate the best classification threshold. Results The cohort included 67 cases of non-organic catatonia and 37 cases of organic catatonia. ROC analysis showed that the CAUS performance in discriminating both organic catatonia vs. non-organic catatonia, and autoimmune catatonia vs. non-organic catatonia was excellent (Area Under the Curve = 0.99). In both analyses, for a CAUS threshold ≥ 5, accuracy equaled to 0.96. Conclusion Regarding juvenile catatonia, the use of the CAUS score algorithm combining a therapeutic challenge and a threshold ≥ 5 may help to diagnose and treat autoimmune conditions even without formal identification of auto-antibodies.

Background Despite the high prevalence of child abuse and neglect and its consequences on health, very few studies have evaluated the trajectories of children in placement in France, and there are no cost studies available. Objective To estimate the cost of abuse and neglect in children in placement before their 4th birthday in France. Participants and setting A cohort of children in placement before their 4th birthday in a single nursery between February 1994 and June 2001 was followed from birth until they left care. Methods Child protective services (CPS), health, health and social, and judiciary services utilization was derived from a qualitative analysis of the children's files and valued with their unit costs in 2013 euros from the societal perspective. Total costs and mean annual cost per child followed by CPS were calculated overall, by cost category, and by status at admission to the nursery. Results 129 children were included. Mean age at first admission was 1.9 years (SD = 1.3). The mean length of follow-up by CPS was 14.3 years (SD = 5.0). Mean annual cost per child was estimated at €53,265 (SD = 42,077), with CPS costs representing 78% of costs. 80% of health care costs were due to psychiatric care. Children with no identified psychosocial risk factors had significantly higher psychiatric care costs and health and social care costs than pre-term children and children with identified psychosocial risk factors. Conclusion More research should be carried out to address early and comprehensively the multiple needs of children followed by CPS in the short- and long-term.

International audience; Intraoperative direct stimulation during surgery while awake is considered to be the gold standard for identifying eloquent cortical sites. Only a few studies have referenced the psychologic impact of this event in the pediatric population.OBJECTIVE:The aim of this clinical study is to present the psychologic aspects of surgery while awake in children. We question the psychiatric contraindications and age limits, as well as the impact on children, with particular attention to the psychologic conditioning and experience of these patients.METHODS:Seven patients aged 8-16 years old with brain lesions were operated on while awake between 2008 and 2015. Data collected included perception and memories of surgery and diagnosis and also their real-life experience after surgery. Symptoms of posttraumatic stress disorder or acute stress were investigated.RESULTS:None of the children had initial psychiatric problems. No psychiatric diagnosis was made before surgery. The child psychiatrist did not contraindicate any child for this procedure. Patients experienced little anticipatory anxiety. No child presented symptoms of posttraumatic stress disorder or acute stress.CONCLUSIONS:The results are encouraging, allowing us to contemplate using brain surgery while awake for children without particular worries about the psychologic aspect.Copyright © 2017 Elsevier Inc. All rights reserved.

Organic mental disorders are different and further revealed by increasingly advanced research. They are nevertheless misunderstood, without consensus, and raise clinical, diagnostic, and therapeutic questions. These disorders require effective collaboration between practitioners such as pediatricians and child psychiatrists. The subject should not disappear behind the complexity related to the clinical expression of these symptoms. Based on three cases of autoimmune encephalitis, we offer a reflection on the management and assessment of these diseases by a multidisciplinary team with the intention of providing optimal management. The aim of this paper is to override an initial divide posed by a particular clinical presentation. We would like to shed light on the place and legitimacy of child psychiatrists and their clinical expertise. This does not exclude the need for care of the symptoms, considering each subject and her experience. Follow-up is necessary because of the possible, often traumatic, functional and psychological consequences. Finally, the presence of each professional should be specified when the psychiatric symptoms appear to be the result of an organic disease in order to better support the subject in his suffering body.

Resume L’etude des comorbidites, des facteurs de risque de pathologies organiques ou de la baisse de l’esperance de vie des patients atteints de pathologies mentales, notamment psychotiques, fait l’objet de nombreuses publications. La prise en charge, l’accompagnement, notamment en soins palliatifs, de ces patients, mais egalement le vecu tant des patients que des soignants dans ce type de situation sont plus rarement abordes. A partir de l’histoire de Pierre, patient suivi pour une schizophrenie paranoide et atteint d’un cancer du poumon au pronostic letal a court terme, nous evoquons l’accompagnement, la prise en charge de ces patients dans le cadre de soins palliatifs en secteur specialise psychiatrique et la complexite que cela peut representer, tant pour les patients que pour les equipes soignantes. Ainsi, le lieu de prise en charge mais egalement l’evaluation du comportement ou de la douleur s’averent a l’origine de reflexions complexes que nous discutons. Nous initions par la suite une reflexion autour des enjeux de cet accompagnement singulier avec les notions de travail du trepas et, plus generalement, des enjeux legaux et ethiques autour des refus de traitements dans ce cadre precis.

International audience; BACKGROUND/PURPOSE: Obesity now affects 3%-4% of the pediatric population and contributes to the increase in cardiac mortality in adulthood. Bariatric surgery is the best treatment for weight loss and the obesity-associated comorbidities in adults. We report here our experience of laparoscopic adjustable gastric banding (LAGB) in adolescents.METHODS: The medical charts of the first 16 patients operated on in our center were reviewed. Data were compiled concerning weight loss, physical and biological comorbidities, health-related quality of life (QOL) and surgical complications before surgery and during 24months of follow-up.RESULTS: The maximal pre-operative median body mass index was 43.0kg·m(-2), decreasing to 33.0kg·m(-2) at 2years post-LAGB, which corresponded to a 49.2% excess body weight loss (pCONCLUSION: LAGB is well tolerated in adolescents and shows a beneficial impact on weight loss and obesity-related comorbidities. Associated with global management, it may have a positive impact on patients' QOL and social and psychological status.

Background The results of medical treatment of severe obesity in the adolescent population (balanced diet and physical activity) are often unsatisfactory, and bariatric surgery is questioned. The psychological determinants for requesting bariatric surgery in these adolescents are unclear. The objective of this study was to report the psychiatric and psychological aspects as well as the determinants of the medical decision for surgery in a cohort of obese adolescents requesting bariatric surgery by laparoscopic adjustable gastric banding. Methods Thirty-five adolescents (12.3–17.7 years of age), were recruited from January 2007 to December 2012. Semistructured interviews were conducted. Results Fifty-four percent of the adolescents had a psychiatric history and 85% had psychiatric comorbidities. In adolescents undergoing surgery, excess weight loss was 46% after 1 year and 51% after 2 years. For patients not receiving surgery, excess weight loss was 0.43% after 1 year (P = 0.001). Compliance with medical treatment was the only significant element contributing to the decision to perform surgery. Results in terms of satisfaction and perception 1 and 2 years after surgery were encouraging. Conclusion Bariatric surgery is feasible in young patients and produces good results in terms of excess weight loss. We argue that compliance with medical treatment is probably one of the most important elements for making the decision to perform bariatric surgery and in excess weight loss after surgery. We probably need to focus on the compliance of young patients and evaluate how this can be improved.

La question de la temporalite est a la fois au centre de notre pratique quotidienne en pedopsychiatrie de liaison et au centre de la problematique psychique concernant les maladies chroniques de l’enfant et de l’adolescent. Cet article met en perspective la notion de temps au sein meme des maladies chroniques de l’enfant et de l’adolescent dont l’evolution se prolonge, avec un effet de sideration chez le sujet et sa famille, et le concept de pulsion de mort. Deux situations cliniques s’articulant autour du processus adolescent illustrent notre propos. Il n’est pas question ici de remettre en cause le savoir medical ou de nier la maladie, mais de relancer une histoire, afin que les enfants et adolescents, ainsi que leurs familles, puissent se reapproprier le savoir de l’autre et l’integrer a leur propre narration.

Severe obesity (body mass index>120% of BMI IOTF-30 cut off) and morbid obesity (BMI>140% of BMI IOTF-30 cut off) affect 5 to 10% of obese adolescents in France. Organic complications can be found in about 50% of these patients, and depressive symptoms in one-third of them. Finally, over 70% will suffer from adult morbid obesity associated with a marked increase in morbidity and mortality. However, the reversion of obesity strongly decreases, and may even cancels, these risks. In controlled randomized studies, lifestyle interventions have limited effectiveness on BMI in children (and none in adolescents). Bariatric surgery has been shown to have short-term effectiveness in adolescents with severe and morbid obesity: the average BMI loss after gastric banding was 11.6kg/m2 (95% confidence interval from 9.8 to 13.4), 16.6kg/m2 (95% confidence interval from 13.4 to 19.8) after bypass, and 14.1kg/m2 (95% confidence interval 10.8 to 17.5) after sleeve gastrectomy. The resolution of comorbidities was the main aim, as well as the improvement of quality of life. This is not a simple surgical intervention, and minor side effects have been reported in approximately 10-15% of teenagers who underwent surgery (more common with the gastric band), and severe side effects in nearly 1-5% (mainly with bypass). In France, recommendations regarding indications, the care pathway, multidisciplinary meetings, reference management structures and postoperative care have been published by the French National Health Authority (HAS) in 2016 to provide a framework for bariatric surgery in underage patients.