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Background Symptoms of anxiety and depression are common in adolescents with a loved one in an intensive care unit (ICU) and are known precursors of posttraumatic stress disorder (PTSD). Objectives To assess the prevalence of PTSD and associated factors in adolescent (age 12–17 years) relatives of patients in an ICU with an open visitation policy. Methods One year after the patient was discharged from the ICU, eligible adolescent relatives completed a satisfaction survey, anxiety history questionnaire, and psychometric evaluations (Hospital Anxiety and Depression Scale and 8-item Children’s Revised Impact of Event Scale). Results Thirty-two patients intubated for >2 days and with a Simplified Acute Physiology Score II >30 were included. Forty-six adolescents with first- to third-degree relationships to the patient, and in regular contact (≥monthly) with the patient before hospitalization, were enrolled. The prevalence of PTSD among the adolescents was 33%. Adolescents who visited the ICU were less likely to report feelings of regret than those who did not visit the ICU (2% vs 9%, P = .01). A past sense of threat (odds ratio [95% CI], 19.4 [1.9-201.2]; P = .01) and anxiety and depression symptoms (odds ratio [95% CI], 9.6 [1.4-63.7]; P = .02) were independent factors associated with probable PTSD. Conclusions A cautiously prepared open visiting policy should be maintained for adolescents with a relative in the ICU, because it could prevent feelings of regret and subsequent PTSD. Adolescents with risk factors should be screened and followed up.

Summary Introduction Crack cocaine use disorder (CCUD) is a major public health with a strong heritability component. Objectives This study was aimed to investigate the putative association between the dopamine transporter gene (DAT1/SLC6A3) and crack-cocaine use disorders (CCUD) as well as the possible involvement of attention-deficit hyperactivity disorder (ADHD), impulsivity and sensation-seeking. Methods Seventy-seven male subjects with CCUD were compared with 60 male control subjects of Afro-Caribbean origin. The Barratt Impulsivity Scale, the Wender Utah scale Scale-25 item and the Zuckerman Sensation-Seeking Scale were used. The subjects’ DNAs were genotyped by quantitative PCR (TaqMan method). Results We found an association with two SNPs (rs6347 and rs27048) of the DAT gene in crack-cocaine use disorder, and a significantly lower frequency of one of the three haplotype blocks of the DAT gene (AT haplotype, defined by the two previous SNPs) and CCUD. Conclusion DAT1 rs6347 and rs27048 polymorphisms seem to be associated with CCUD. The risk-effect of these polymorphisms appeared to be specific to individuals who are crack users rather than being driven by impulsivity or ADHD.

Objective To analyse the epidemiological data on suicide in French Polynesia (FP). Methods Data on suicides were collected from the Public Health Direction, Judicial Police Investigations Court of Justice records, the Centre d’Opérations et de Renseignements de la Gendarmerie, patient records for those hospitalized in psychiatry and from psychological autopsies. Results The dataset consisted of 316 suicide cases in FP over 25 years (1992–2016). In FP, suicide was more frequent in men (sex ratio 3.2:1), young people (mean age, 34.4 years) and individuals with previously diagnosed psychiatric disorders (100 of 316; 31.6%) The most common method of suicide was hanging (276 of 316; 87.3%). A history of previous suicide attempts was found in 25 of 56 (44.6%) of suicide cases, when documented. The most common potential triggering factors for suicide were emotional problems. The suicide rates have remained stable during 1992–2016 (mean 10.6/100 000 inhabitants per year), with periods of economic crises increasing suicide rates. Conclusions These results provide valuable information to enable the effective targeting of suicide prevention strategies toward those at high risk. Economic crises had larger impacts in the French overseas territories than mainland France. Given the unprecedented economic impact of the Covid-19 pandemic in FP, there is an urgent need to implement suicide epidemiological surveillance and prevention programmes.

Objectives : Cocaine dependence has a strong heritability component. The aim of this study was to investigate the putative association between the serotonin 2B receptor gene (HTR2B), crack use disorders and impulsivity. Methods : A French Caribbean male population of patients with crack use disorders (n=80) w as compared to healthy male controls (n=60). Comorbid ADHD and impulsivity were assessed. Five Single Nucleotide Polymorphisms (SNPs) in the HTR2B gene on chromosome 2 were selected: rs643700, rs 6736017, rs1549339, rs17586428 and rs3806545 Thes e five SNPs were chosen to cover most of the linkage disequilibrium (LD) blocks in HTR2B. The French translation of the Baratt Impulsivity Scale BIS -11 was used to evaluate impulsivity. Comorbid ADHD was diagnosed using the Wender Utah Rating Scale-25 item for the Attention Deficit-Hyperactivity Disorder. Results : We have found a positive association between the rs6736017 polymorphism and crack use disorders in a French Afro-caribbean male population. Conclusion : The risk effect of HTR2B rs6736017 appeare d to be specific to individuals who are crack users rather than being driven by impulsivity alone or ADHD alone

Objectives To assess understudied, alternative suicide prevention modalities in a mental health care setting. Methods This was a prospective study of patients (n = 140, 68 cases and 72 controls) who were admitted to hospital or who contacted an SOS suicide crisis line for suicidal ideation or attempts. Psychiatric diagnoses (Mini-International Neuropsychiatric Interview) and intensity of anxiety/depression/suicidality (Hamilton Anxiety Rating Scale, Montgomery–Åsberg Depression Rating Scale, and Beck Scale for Suicidal Ideation) were assessed. All intervention group subjects received a crisis card with a crisis line number, interviews with psychologists or volunteers and a telephone call on days 10 to 21, then 6 months later. These subjects also had a choice between two further 4-month interventions: body contact care or mobile intervention team visits. Results The interventions significantly reduced the number of suicide attempts and suicide (3%) at 6 months compared with the control condition (12%). There were fewer losses to follow-up in the intervention group (7.35%) than in the control group (9.72%). Conclusions The results favour the implementation of integrated care and maintaining contact in suicide prevention.

International audience; BACKGROUND:In September 2017, the Hurricane Irma devastated the islands of Saint-Martin and Saint-Barthelemy (French West Indies). This was a particularly distressing time for the local healthcare staff in charge of rescuing the population. The aim of this study was to identify the explanatory factors of post-traumatic distress and burnout in hospital staff.METHODS:An anonymous questionnaire was sent to all 509 hospital workers of Saint-Martin and Saint-Barthelemy. Post-traumatic distress and burnout was assessed using the Post-Traumatic Stress Disorder Checklist (PCL-S) and Copenhagen Burnout Inventory (CBI) scales. Bivariate and multivariate analyses were used to determine the explanatory variables for these two psychological disorders.RESULTS:Two hundred and sixty-two questionnaires were completed (response rate of 51.7%). The explanatory factors of post-traumatic distress were female gender (OR = 12.93, 95% CI: 2.70-232.10), electricity shortages (OR = 2.92, 95% CI: 1.13-8.19) and home damage (OR = 1.16, 95% CI [1.02-1.33]). In parallel, the explanatory factors of burnout were post-traumatic distress (OR: 10.42, 95% CI: 4.72-25.58), female gender (OR = 2,41, 95% CI: 1.24-5.02) and paramedical staff (OR = 2,53, 95% CI: 1.15-6.21). In the multivariate analysis, only burnout was significantly associated with post-traumatic distress (OR = 9.26, 95% CI: 4.11-23.14).CONCLUSIONS:Six months after Irma, post-traumatic distress among hospital staff was strongly linked to burnout. This study revealed the lack of electricity as a new factor related to post-traumatic distress. It also suggested that psychological intervention should be strengthened.

Studies of adolescent suicide screening tools have increased with the development of questionnaires that can be used in paediatric emergency departments. This article proposes a literature review of the acceptability of such interventions. Although these tools are well accepted when they are systematized, their usefulness is determined by the availability of child psychiatric care with the right balance between the adolescent's confidentiality and parental involvement.

Background French Guiana has the highest incarceration rate among French territories, it is higher than that of Brazil, Colombia or Venezuela. It is well known that mental health problems are over-represented in correctional facilities. Our objectives were to describe the prevalence of various psychiatric conditions and to study factors associated with violence and repeated offenses among arriving detainees at the sole correctional facility of French Guiana. Methods The study was cross-sectional. All consenting new adult prisoners incarcerated between 18/09/2013 and 31/12/2014 at the penitentiary centre of French Guiana were included. The Mini International Neuropsychiatric Interview (MINI) was used to screen for psychiatric diagnoses. In addition sociodemographic data was collected. Results Overall 647 men and 60 women were included. The participation rate was 90%.Overall 72% of patients had at least one psychiatric diagnosis (Fig. 2). Twenty percent had three or more diagnoses. Violent index offences were not more frequent among those with a psychiatric diagnosis (crude odds ratio 1.3 (95%CI = 0.9–2), P = 0.11. Multivariate analysis showed that after adjusting for sex and age, psychosis, suicidality and post-traumatic stress disorder were independently associated with violent offences. Generalized anxiety disorder was less likely to be associated with incarceration for violent offences. Having a history of a previous incarceration was significantly associated with a psychiatric condition in general (any diagnosis) OR = 3 (95%CI = 2–4.3), P

Objective ICU experience is linked to anxiety and depression symptomatology in family members of patients. Minors may be forbidden from visiting. To bring practices in line with evidence, we determined the prevalence of anxiety and depression symptomatology in adolescents visiting a relative in the ICU. Design One-year prospective observational monocenter study. Setting Medical-surgical ICU, University Hospital of Martinique. Patients Forty-one patients intubated for more than 2 days; 53 adolescents (12-17 yr) first- to third-degree relatives in regular contact (minimum once a month) with patient before hospitalization. Interventions Adolescents with unrestricted ICU access completed a satisfaction survey, anxiety history questionnaire, and psychometric evaluation (Hospital Anxiety and Depression Scale) before the patient's 15th day of hospitalization and extubation. Measurements and main results Forty adolescents (75.5%) visited their relative. Possible and probable anxiety and depression symptomatology prevalence was 35.9% and 18.9%, respectively, with no significant difference according to ICU visiting status. Most (80%) reported a lack of information, 40% insufficient consideration, and 27.5% misunderstood the reason for hospitalization. Two (5%) regretted visiting. Probable anxiety and depression symptomatology was associated with first-degree relationship (odds ratio, 9.1 [95% CI, 1.1-78.9]; p = 0.045), past exposure to a traumatic event (odds ratio, 8.7 [1.1-69.0]; p = 0.040) and past sense of threat (odds ratio, 10.4 [1.1-94.5]; p = 0.038). Conclusions Anxiety and depression symptomatology is common in adolescent family members of ICU patients. An open visiting policy for adolescents is recommended, with visit planning, information meetings, and individual support from ICU staff.

Due to many available forms (powder, pasta base, freebase and crack…) and because of multiple routes of administration (intranasal, intravenous, or smoked), cocaine has become in 30 years one of the most consumed illegal drugs worldwide, after cannabis. While the frequency of consumption decreases in North America, it continues to rise in Europe, and in some countries in South America, including Brazil, despite a growing knowledge of its specific effects, physical complications and psychiatric consequences. Elsewhere (notably in Asia and Indian Ocean), amphetamine and other stimulants (including methamphetamine), whose properties and patterns of use are very similar to those of cocaine, tend to replace it. Another amphetamine derivative, MDMA or ecstasy, is also consumed by many young people of less than 25 years, in Europe and North America, in a festive setting, with specific consequences and special procedures of care. Although there is currently no consensus for a specific medication, the most appropriate therapeutic approach seems to involve a psychosocial treatment associated with an anticraving medication, which will reduce compulsive desire to consume, in order to facilitate the psychotherapeutic and social care. However, pharmacological research remains very active, and many options are explored (GABAergic or dopaminergic agonists, amphetamine derivatives with long half-life, vaccine…), whether to treat addiction to cocaine or to methamphetamine.

France is one of the first countries to have passed specific legislation concerning “mental harassment” (In French the term used in the legislation is “harcelement moral” referring to harassment or bullying leading to mental or psychological distress.) in the workplace. However, the definition of mental harassment at work remains fairly vague. It is, indeed, a complex issue, since no objective and precise consensual definition has been given so far. The objective of this study is to clarify the criteria that French judges consider as characteristic of mental harassment, and to check whether the specific links between mental harassment at work and PTSD pointed to in recent international studies have been taken into account. This study proposes the main lines for debate in countries that have not yet adopted legal clauses on mental harassment at work. Our study is based on a sample of 22 people who were legally recognised as having been mentally harassed at work; this sample is taken as representative of all court decisions passed on harassment and published as such on the French Ministry of Justice website. To establish whether they were considering a case of harassment, the judges based their decisions on the nature of the accusations. In all cases (22/22), the charges brought against the defendant had to do with offences against the employee’s dignity. Five cases out of 22 dealt with an offence infringing their rights, 10 cases out of 22 related to the employee’s future within the company being compromised, while half of the cases (11/22) concerned a deterioration in the person’s health. In more than half of the cases, the judges also looked for other factors, such as repetition and duration of the period of harassment. Whenever the judges noted a deterioration in the victim’s mental health, they also referred to medical certificates reporting anxio-depressive syndromes or psychological disorders without providing further detail. No PTSD-like symptomatology was mentioned among these cases, although several studies have shown that many victims of mental harassment at work have specific symptoms of PTSD. This study is the first study to be carried out on mental harassment at work and to refer to court decisions since the law was promulgated in France (2002). It appears that, in order to be recognised as a victim of mental harassment at work, numerous proofs of harassment or bullying need to be produced. It must have been repeated and have led to consequences in several domains. Several attestations and documents are required demonstrating clearly that harassment or bullying did indeed occur. Further to this, although to date judges have not considered PTSD to be an element contributing to the presumption of harassment, connections between bullying or harassment and clinical signs of PTSD have been attested by several studies that confirm that bullied victims can suffer from PTSD-like symptoms, although they do not necessarily match the strict DSM-IV criteria (absence of A1 criterion). It would seem advisable to request psychiatric examination in cases of harassment.

Resume Introduction Le retentissement d’une catastrophe est le plus souvent evalue dans son impact psychotraumatologique immediat, mais plusieurs travaux depuis l’attentat du 11 septembre 2001 en ont souligne le retentissement sur les comportements suicidaires. L’objectif de notre etude etait d’analyser les liens entre la canicule survenue en France au cours du mois d’aout 2003 et ayant entraine plus de 14 000 deces en exces par rapport aux annees precedentes a la meme periode, et les troubles psychiatriques dans une population donnee. Methode La population etudiee a ete celle des consultants des urgences psychiatriques d’un hopital general parisien (hopital Tenon). Nous avons compare la frequentation et les motifs de consultations, notamment crise suicidaire, trouble depressif, crise d’angoisse, et reaction a un facteur de stress, entre les mois de juin et octobre pour les annees 2002 et 2003. Nous avons analyse 1632 dossiers pour ces 2 periodes. Resultats Pendant la canicule, le nombre de comportements suicidaires a ete significativement reduit : il representait 12,3 % des consultations d’urgence psychiatrique en 2003 versus 25 % en 2002 sur la meme periode. D’autre part, pendant cette meme periode le nombre d’hospitalisations en psychiatrie a significativement augmente : 32,1 % des patients recus en 2003 versus 15,4 % en 2002. Discussion Ces resultats sont comparables a ceux des etudes internationales analysant l’influence des catastrophes sur les troubles psychiatriques observes au sein de la population exposee. Un contexte de crise pour une societe donnee semble conduire a une meilleure cohesion, une solidarite entre les individus, phenomene qu’il pourrait etre bon de renforcer dans le cadre de la prevention du suicide.

The World Health Organization Suicide trends in at-risk territories study is a multi-site regional research program operating first in French Polynesia and countries of the Western Pacific, then extended to the world. The aims of the study were to establish a monitoring system for suicidal behaviors and to conduct a randomised control trial intervention for non-fatal suicidal behaviors. The latter part is the purpose of the present article. Over the period 2008-2010, 515 patients were admitted at the Emergency Department of the Centre Hospitalier de Polynésie Française for suicidal behavior. Those then hospitalized in the Psychiatry Emergency Unit were asked to be involved in the study and randomly allocated to either Treatment As Usual (TAU) or TAU plus Brief Intervention and Contact (BIC), which provides a psycho-education session and a follow-up of 9 phone contacts over an 18-months period. One hundred persons were assigned to TAU, while 100 participants were allocated to the BIC group. At the end of the follow-up there were no significant differences between the two groups in terms of number of presentations to the hospital for repeated suicidal behaviors. Although the study could not demonstrate the superiority of a treatment over the other, nevertheless – given its importance – the investigation captured public attention and was able to contribute to the awareness of the need of suicide prevention in French Polynesia. The BIC model of intervention seemed to particularly suit the geographical and health care context of the country.

International audience; Objectives: This is the first research article examining non-fatal suicidal behaviours (NFSB) in French Polynesia. The study was conducted in the frames of the WHO/START Study in 2008–2010. The main objective of the investigation was to obtain reliable data in order to develop evidence-based suicide prevention strategies. Method: Interviews with people presenting with NFSB at the Emergency Department (ED) of the French Polynesia Hospital (CHPF) were conducted by emergency and psychiatry departments' staff examining socio-demographic and clinical information and motives triggering suicidal behaviour. Odds ratios and rate ratios with 95% confidence intervals were calculated. Results: There were 556 presentations of NFSB by 515 persons at the ED of CHPF (ratio 1.08) with the average rate of 75 per 100,000 for those treated in the hospital. An estimate of cases occurring in remote islands might bring the rate for the whole French Polynesia around 94 per 100,000. NFSB was more prevalent in females; rates for both genders were highest in the age group 25–35 years and 15–24 years. The main suicide method was drug poisoning by psychotropic drugs. The most frequent psychiatric disorder was mood disorder (45.3%); however, 26% of subjects had no 'major' psychiatric disorders, with 14.5% without a psychiatric diagnosis or only reactive disorders (F43-11.7%). There was a high prevalence of previous NFSB (52.1%). Limitations: Study includes only NFSB seeking medical help from the biggest hospital in the country. Conclusion: Suicide prevention activities specific to the findings and the socio-cultural context of French Polynesia should be considered.

Summary France has been subjected to terrorism for the past 15 years. Several epidemiological studies have pointed to the high prevalence and severity of PTSD symptoms among the victims. Terrorism-related injuries and time elapsed since the trauma were associated with a negative prognosis. Since 1997, these findings led to the development of a medico-psychological intervention network accompanying the traditional emergency medical team, and giving pre-hospital psychological emergency care to provide secondary prevention. Specialized hospital-based psychiatric services were developed to complement this front-line network, offering an innovative system of care. Studies are needed to examine the effectiveness of this system in reducing trauma-related disorders.

OBJECTIVES Cocaine intoxication can induce transient psychotic symptoms. The principal aim of this study was to determine sociodemographic and clinical characteristics associated with cocaine-induced psychosis (CIP) and to identify clinical factors predicting CIP in crack cocaine smokers in Martinique. The second aim was to identify clinical factors associated with severity of CIP, assessed with the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP). METHODS Fifty-three cocaine-dependent smokers (45 men and 8 women) seeking treatment for cocaine dependence were included. Patients were assessed using the Cocaine Experience Questionnaire (CEQ), an instrument for the identification of cocaine-induced paranoia, and a French version of the SAPS-CIP, for the severity of CIP. RESULTS Thirty-five (66%) patients reported cocaine-induced paranoia on the CEQ (CIP(+) patients). The mean SAPS-CIP total score was 6.1 ± 3.7, with a significant difference between CIP(+) and CIP(-) patients (P < 0.0001). Age at first cannabis use was associated with occurrence of CIP on the CEQ, and adolescent-onset cannabis use was associated with severity of hallucinations score on the SAPS-CIP. CONCLUSIONS Cocaine-induced psychosis is frequent in crack cocaine smokers in Martinique, and early cannabis use is associated with the occurrence and the severity of psychotic symptoms during cocaine intoxication in this population. Patients developing psychotic symptoms during cocaine use began smoking cannabis earlier during adolescence than patients without CIP. These results confirm those of previous studies, highlighting the need to better assess early cannabis use in cocaine users, because early cannabis use is associated with severity of CIP.

BackgroundHow best to plan and provide psychosocial care following disasters remains keenly debated.AimsTo develop evidence-informed post-disaster psychosocial management guidelines.MethodA three-round web-based Delphi process was conducted. One hundred and six experts rated the importance of statements generated from existing evidence using a one to nine scale. Participants reassessed their original scores in the light of others' responses in the subsequent rounds.ResultsA total of 80 (72%) of 111 statements achieved consensus for inclusion. The statement ‘all responses should provide access to pharmacological assessment and management’ did not achieve consensus. The final guidelines recommend that every area has a multi-agency psychosocial care planning group, that responses provide general support, access to social, physical and psychological support and that specific mental health interventions are only provided if indicated by a comprehensive assessment. Trauma-focused cognitive–behavioural therapy (CBT) is recommended for acute stress disorder or acute post-traumatic stress disorder, with other treatments with an evidence base for chronic post-traumatic stress disorder being made available if trauma-focused CBT is not tolerated.ConclusionsThe Delphi process allowed a consensus to be achieved in an area where there are limitations to the current evidence.

ObjectifsL’acupuncture est de plus en plus utilisée en addictologie [1,2]. Au CHU de Martinique, les patients présentant des addictions aux substances en bénéficient depuis une quinzaine d’années. Notre étude permet d’évaluer les bienfaits subjectifs de l’acupuncture chez ces patients en utilisant les Échelles Visuelles Analogiques avant et après les séances.MéthodesCes évaluations ont été proposées à l’ensemble des patients venus faire des séances d’acupuncture durant le mois de juillet 2012. Les patients ont côté sur une échelle entre 0 et 10 leurs fatigue, bien-être, stress/anxiété, détente, douleur physique avant et après les séances.RésultatsCent six fiches anonymes avant/après ont été analysées. Trente-cinq patients déclarent être abstinents, 53 déclarent être consommateurs réguliers d’une ou plusieurs substances (42 % alcool, 58 % tabac, 20 % crack, 38 % cannabis) et 18 sont données manquantes. L’ensemble des patients ont rapporté une diminution de leurs anxiété/stress (p = 0,0001), sensation de fatigue (p = 0,001) et douleur physique (p = 0,0001). Ils signalent également une amélioration de leur détente (p = 0,001) et de leur bien-être (p = 0,001). ConclusionDans notre population, les séances d’acupuncture semblent améliorer les ressentis des patients dans plusieurs domaines. Il sera intéressant de poursuivre cette étude en étudiant non seulement les biais liés à la relaxation et aux croyances magico-religieuses mais aussi en étudiant différents paramètres objectifs comme la diminution de la consommation et le cardio feedback.

IntroductionLes patients souffrant de maladies mentales meurent en moyenne 25 ans plus tôt que la population générale. Les causes de mortalité sont notamment liées aux maladies cardiovasculaires, en lien avec le syndrome métabolique. Peu de littérature explore les comorbidités somatiques et psychiatriques dans les Antilles françaises. L’objectif principal de cette étude préliminaire est de décrire au centre de crise du CHU de Martinique la population hospitalisée sur le plan somatique (syndrome métabolique) et sur le plan des comorbidités psychiatriques (dont les comorbidités psychotraumatiques). MethodsDans cette étude prospective où 49 patients ont été inclus de façon aléatoire entre février et juillet 2013, nous avons évalué les éléments suivants : syndrome métabolique, MINI, THQ, IESR. RésultatsCette population est âgée de 44 ans en moyenne. Le syndrome métabolique est retrouvé chez 33 % de la population. Les comorbidités psychiatriques : 75 % de dépression, 57 % de risque suicidaire moyen à élevé. Au niveau des évènements traumatisants (médiane du nombre d’évènements traumatisants à 6) : 45 % déclarent avoir subi des agressions sexuelles, 43 % des catastrophes naturelles. Le score total de l’IESR a un score médian à 37,5. ConclusionCes résultats rappellent la nécessité de systématiser la recherche du syndrome métabolique et des évènements traumatiques en hospitalisation en psychiatrie.

Hypothesis A suicide attempt is an major event that creates harm on both family and close relatives, that can be measured in terms of traumatic stress and medico-economic impact (costs). Each year, 3.750.000 French people are concerned by a suicide attempt of a relative (or close person). Subjects Male or female, older than 16, being a relative of a suicide attempter (i.e. living in the same house as the suicide attempter). 171 families were included (171 suicide attempters and 171 « family informants »). These subjects were compared to IRDES datas on French population (Institute of Research and Documentation on Health Economy ; sample of 20.000 subjects, representing 95% of the French families). All subjects were reassessed by phone at 3 month and 1 year. Results 80% of the relatives declare “being fine” at 1 year; the 20% that declare being “not so well” are important to qualify, the sooner after the suicide attempt. An explicative model trying to evaluate the risk of being “not so well” at 1 year is possible ; this model is highly represented by the psychotraumatic impact of the confrontation with the suicide attempt. On the economic plan, we can observe a great stability in healthcare contacts at 1 year (hospitalizations, GP or Specialists contacts, other kind of care contact…), contrasting with a big increase in medication use (× 2.37 in comparison with IRDES population); all the medication types being concerned, psychotropic and others. The question of a self-medication partly unconscious is raised.

Georges Brousse1,2, Benjamin Arnaud1, Jordane Durand Roger1, Julie Geneste1, Delphine Bourguet1, Frederic Zaplana1, Olivier Blanc1, Jeannot Schmidt1,2, Louis Jehel31CHU Clermont Ferrand, Unité Urgences Psychiatriques, 28 place Henri Dunant BP 69, 63003 Clermont-Ferrand Cedex 01, France; 2Univ Clermont 1, UFR médecine, Clermont-Ferrand, F63001 France; 3Hopital Tenon (CHU APHP) 4 rue de la Chine 75020, France, INSERM U669Abstract: Our aim was to assess the influence of the coping strategies employed for the management of traumatic events on the occurrence of dissociation and traumatic disorders. We carried out a 1-year retrospective study of the cognitive management of a traumatic event in 18 subjects involved in the same road vehicle accident. The diagnosis of post-traumatic stress disorder (PTSD) was made for 33.3% of the participants. The participants with a PTSD diagnosis 1 year after the event used emotion-centered strategies during the event more often than did those with no PTSD, P< 0.02. In the year after the traumatic event, our results show a strong link between the intensity of PTSD and the severity of the post-traumatic symptoms like dissociation (P = 0.032) and the use of emotion-centered strategies (P = 0.004). Moreover, the participants who presented Peritraumatic Dissociative Experiences Questionnaire scores above 15 made greater use of emotion-centered coping strategies than did those who did not show dissociation, P < 0.04. Our results confirm that the cognitive management of traumatic events may play an essential role in the development of a state of post-traumatic stress in the aftermath of a violent event.Keywords: trauma, coping, emotions, peritraumatic dissociation, post-traumatic stress disorder