Oncology clinicians' feelings towards patients presented in supervision: A pre-post assessment using the feeling word checklist.

OBJECTIVE: Clinical supervision of oncology clinicians by psycho-oncologists is an important means of psychosocial competence transfer and support. Research on this essential liaison activity remains scarce. The aim of this study was to assess the impact of supervision on oncology clinicians' feelings towards patients presented in supervision. METHODS: Oncology clinicians' (n = 23) feelings towards patients presented in supervision were assessed with the Feeling Word Checklist (FWC). The FWC was filled in by supervisees prior and after their supervision sessions (n = 91), which were conducted by experienced supervisors (n = 6). Pre- post-modification of feelings was evaluated based on a selection of FWC items, which were beforehand considered as likely to change in a beneficial supervision. Items were evaluated on session level using t-tests for dependent groups. Composite scores were calculated for feelings expected to raise and feelings expected to decrease and analysed on the level of supervisees. RESULTS: Feelings related to threats, loss of orientation or hostility such as "anxious", "overwhelmed", "impotent", "confused", "angry", "depreciated" and "guilty" decreased significantly after supervision, while feelings related to the resume of the relationship ("attentive", "happy"), a better understanding of the patient ("empathic"), a regain of control ("confident") and being "useful" significantly increased. Feeling "interested" and "calm" remained unchanged. Significant increase or decrease in the composite scores for supervisees confirmed these results. CONCLUSIONS: This study demonstrates modification of feelings towards patients presented in supervision. This modification corresponds to the normative, formative, and especially restorative function (support of the clinician) of supervision.

The Impact of the COVID-19 Pandemic on Unassisted Suicide and Assisted Suicide Rates in French-Speaking Switzerland: Differences by Gender.

Aims: Most studies on the impact of COVID-19 have shown a decrease or no change in unassisted suicide rates, but effects on assisted suicide have not been studied. We aimed to estimate the association between the COVID-19 pandemic and both types of suicide. Methods: Between 2017 and 2021, 1280 assisted suicides and 535 unassisted suicides were recorded in three Swiss cantons. We conducted descriptive and time series analyses on monthly suicide rates, categorized by gender. Results: Among women, a decrease in assisted suicide rates was found during the acute phases of the pandemic. Among men, assisted suicide rates increased gradually from the onset of the pandemic. Regarding unassisted suicide rates, no significant change was observed in women, while in men, there was a decrease, which was larger at the end than at the onset. Conclusions: COVID-19 had contrasting effects on assisted and unassisted men and women suicide rates.

[Transidentites : the relevance of involving psychiatrists]. / Transidentités : pertinence de l'implication des psychiatres.

Psychiatrists play a crucial role in evaluating requests and treatment indications for individuals experiencing gender incongruence, while also providing support throughout the transition process. Their work involves addressing both the psychological and somatic aspects of this journey, facilitating the profound identity changes it entails.

Les psychiatres psychothérapeutes jouent un rôle essentiel pour évaluer les demandes et les indications au traitement des personnes souffrant d'incongruence de genre, et les accompagner dans leur parcours de transition. Leur travail permet d'intégrer les enjeux psychologiques et somatiques de ce cheminement et de soutenir les remaniements identitaires profonds qu'il implique.

Two clinicians for one patient, is it worth it? Patients' perspective on receiving treatment from a pair of clinicians, in a psychiatric emergency and crisis unit.

BACKGROUND: In the field of psychiatric crisis interventions, treatment is commonly provided by multidisciplinary teams in Western countries. However, empirical data on the processes involved in this type of intervention are lacking, in particular from a patient perspective. Our study aims to gain a better understanding of the patients' experience of a treatment setting provided by a pair of clinicians in a psychiatric emergency and crisis intervention unit. Patients' perspective could provide a broader understanding of its advantages (or disadvantages), as well as bring new insight on elements influencing patients' treatment adherence. METHODS: We conducted 12 interviews with former patients treated by a pair of clinicians. The participants' experience, explored with semi-structured questions on their views of the treatment setting, was analyzed by means of thematic analysis using an inductive approach. RESULTS: The majority of participants experienced this setting as advantageous. A broader comprehension of their issues is the benefit most often expressed. A minority experienced seeing two clinicians as disadvantageous (having to talk to several clinicians at a time, change interlocutors, repeat one's story). Participants attributed joint sessions (with both clinicians) mainly to clinical reasons and separate sessions (with one clinician at a time) mainly to logistical ones. CONCLUSIONS: This qualitative study provides first insights into patients' experience of a setting including two clinicians providing emergency and crisis psychiatric care. The results show a perceived clinical gain of such a treatment setting for highly in crisis patients. However, further research is needed to evaluate the benefit of this setting, including the indication for joint or separate sessions as the patient's clinical course evolves.

[Assisted suicide: a need for clarification]. / Suicide assisté : un besoin de clarification.

In Switzerland, altruistic assisted suicide is permitted. We present here the federal regulations, the deontological rules, the provisions adopted by the cantons and other requirements applicable to assisted suicide. Given the complexity of these different rules and the legal questions that remain open, we recommend the preparation of brochures for patients, as well as better training and support for people faced with requests for assisted suicide.

En Suisse, l'assistance altruiste au suicide est admise. Nous présentons ici la règlementation fédérale, les règles déontologiques, les dispositions adoptées par les cantons et les éventuelles autres exigences applicables en matière de suicide assisté. Vu la complexité de ces différentes règles et les questions juridiques encore ouvertes, nous recommandons la rédaction de brochures à destination des patients, ainsi qu'une meilleure formation et encadrement des personnes confrontées à des demandes d'assistance au suicide.

[Psychiatric liaison II: training]. / La liaison psychiatrique II : formation.

Training provided by liaison psychiatry has been considerably developed over the last decades. This article describes how " communication skills" training in oncology evolved to now address interpersonal dimensions of the medical encounter, the clinician's "inner" world and the context. We further present a so-called clinician-centered supervision, which aims to address the intra psychic issues of the clinician; the opportunities and precautions with this specific type of supervision are discussed. Focusing on the clinician facilitates and enriches the clinical encounter and improves medical care.

La formation dispensée par les psychiatres de liaison s'est considérablement développée ces dernières décennies. Cet article présente le cas des formations à la communication en oncologie, en détaillant pourquoi et comment elles ont évolué d'un enseignement centré sur des compétences en communication (skills) à un travail sur la dimension relationnelle de la rencontre, l'étude des mouvements intrapsychiques et une attention portée au contexte. Il décrit ensuite la supervision centrée sur la ou le clinicien·ne, utilisée aujourd'hui à titre exploratoire, en soulignant les opportunités et les précautions nécessaires à sa pratique. Ces exemples montrent en quoi une psychiatrie de liaison qui porte aussi son attention sur le ou la clinicien·ne facilite et enrichit la rencontre clinique et améliore les soins.

[Health services and systems research in psychiatry - The systemic challenge of the ambulatory shift in psychiatry]. / Recherche sur les services et systèmes de santé en psychiatrie - Le défi systémique du virage ambulatoire en psychiatrie.

Health services and systems research examines the match between individual and population health needs and clinical services. In the context of the ambulatory shift in psychiatry, services research is important to ensure the quality of clinical developments, their appropriateness to patient and societal needs, their accessibility, efficiency, implementation and real-world outcomes. The purpose of this article is to present the principles that guide mental health services and systems research and to illustrate them with three examples related to the ambulatory shift in psychiatry. Research on services must be based on both epidemiological and clinical research as well as on partnerships with expert patients.

La recherche sur les services et systèmes de santé examine l'adéquation entre les besoins de santé des individus et de la population et les services cliniques. Dans le contexte du virage ambulatoire en psychiatrie, la recherche sur les services est importante pour assurer la qualité des développements cliniques, leur adéquation aux besoins des patients et de la société, leur accessibilité, leur efficacité, leur mise en œuvre et leurs résultats dans le monde réel. L'objectif de cet article est de présenter les principes qui guident la recherche sur les services et les systèmes de santé mentale et de les illustrer par trois exemples liés au virage ambulatoire en psychiatrie. La recherche sur les services doit se fonder sur la recherche épidémiologique et clinique ainsi que sur des partenariats avec des patients experts.

[Relevance of interventions and support for relatives of an individual who made a suicide attempt]. / Importance de l'accompagnement des proches confrontés à une tentative de suicide.

Suicide and suicide attempt has an impact not only on the suicidal individual but also on his relatives. People expose to suicidal behavior of a close relation are confronted to death or to death threat and are subject to various signs such as anxiety, depression, specially linked to trauma. Therefore, it is essential to support those relatives in their suffering. Three types of intervention are distinguished according to timing: immediate, post-immediate and mid-to-long term interventions.

Le suicide avéré et la tentative de suicide ont un impact important sur la personne suicidaire mais aussi sur ses proches. Ces derniers se voient confrontés à la mort ou à une menace de mort, ce qui peut entraîner la survenue d'une panoplie de syndromes dépressifs et anxieux, surtout liés au traumatisme. Il est essentiel d'intervenir auprès des proches pour accompagner la souffrance psychique souvent présentée. Les interventions proposées sont subdivisées en trois temps distincts : interventions immédiates, postimmédiates et à moyen, voire à long terme.

[The health equity issues of an emergency department fee]. / Instauration d'une taxe aux urgences : enjeux d'équité en santé.

In June 2021, the Swiss parliament accepted a legislative proposal calling for the introduction of a fee to fight emergency department (ED) overcrowding. Although this issue remains a major challenge for health policies, the introduction of such a fee raises many questions, notably regarding health equity. However, other more equitable solutions exist: improving the case management of ED frequent users and improving coordination between ED and primary care.

En juin 2021, le Parlement fédéral a accepté une proposition législative demandant l'instauration d'une taxe aux urgences pour lutter contre leur surfréquentation. Bien que cette problématique demeure un enjeu majeur des politiques de santé, l'instauration d'une telle taxe pose de nombreuses questions, notamment d'équité en santé. Pourtant, d'autres solutions existent, en améliorant la prise en charge des usager-ère-s fréquent-e-s des urgences, ainsi que la coordination entre soins primaires et services d'urgences.

Quality of life was similar in children with congenital diaphragmatic hernia and oesophageal atresia and related to respiratory morbidity.

AIM: To assess quality of life (QoL) in children with congenital diaphragmatic hernia (CDH) and to compare it with oesophageal atresia (OA). METHODS: A cross-sectional study in CDH children (≥7 years) was conducted in Lille University Hospital, France, from January 2013 to April 2014. History, lung function (rest, exercise) and Pediatric Quality of Life Inventory questionnaires (PedsQoL 4.0) were collected. Data of OA children were previously published. RESULTS: Fifty-four CDH patients (male: 53%, median age: 11 years, IQR 9-14) were compared to 54 OA patients (male: 61%, median age: 13 years, IQR: 11-15). CDH children had significantly more frequent history of pneumonia (30% vs 13%), exercise limitation (54% vs 35%) and chest deformity (39% vs 11%); 46% had an obstructive pattern and 66% an abnormal cardiopulmonary exercise test. The median PedsQoL total score in children was 81 (IQR 73-90) in CDH and 81 (IQR 72-91) in OA (P = .8). In CDH, duration of neonatal oxygen therapy, hospitalisation for respiratory disease, exercise limitation, inhaled corticosteroids treatment, chest deformity, abnormal cardiopulmonary exercise test and lower forced expiratory volume in one second were significantly associated with lower QoL scores. CONCLUSION: PedsQoL scores remained satisfactory in CDH children with CDH, with no difference compared to OA. Patients with respiratory morbidity and lung function impairment, who displayed lower scores, should be identified in order to optimise their management in reference centres.

Patients with first versus multiple episodes of self-harm: how do their profiles differ?

BACKGROUND: Self-harm (SH) is among the strongest predictors of further episodes of SH, suicide attempt, and death by suicide. People who repeteadly harm themselves are at even higher risk for suicide. Factors influencing the repetition are important to identify when assessing suicidal risk and thereafter to offer specific interventions. Therefore, this study aimed to compare first versus multiple episodes characteristics in a large sample of patients in french-speaking Switzerland. METHOD: We used the database from the French-speaking Swiss program for monitoring SH. Data of the psychiatric assessment of all adults admitted for SH were collected in the emergency department of four Swiss city hospitals between December 2016 and October 2019. RESULTS: 1730 episodes of SH were included. Several variables were significantly associated with multiple episodes, including diagnosis (over representation of personality disorders and under representation of anxiety disorders), professional activity (Invalidity insurance more frequent) and prior psychiatry care. CONCLUSIONS: Patients suffering from a personality disorder and those with invalidity insurance are at risk for multiple episodes of SH and should be targeted with specific interventions.

[When hotlines remain cold: Psychological support in the time of pandemic]. / Quand le téléphone ne chauffe pas : les hotlines psy en situation de pandémie.

In Switzerland and elsewhere, many psychological support hotlines were set up during the acute phase of the COVID-19 pandemic. Specialists in psychological first aid, in charge of developing and managing these hotlines, had to face an unknown situation, very different from the disasters for which they prepare themselves. Since the pandemic and the associated physical distancing were a potential threat to social cohesion, one could make the hypothesis that, by setting up hotlines, these professionals sought to reintroduce a form of proximity and to care for and cultivate the social connections among people. The pressure, feelings of emergency, anxious anticipation and expectation of the political authorities and the population may have favoured the development of these structures. Other factors certainly also played a role, such as the need to be useful and to exist as professional, or the need to act in order to reduce anxiety related to the pandemic. Altogether, these hotlines were little used, and their usefulness may be questioned. Similar phenomena have been observed - especially in the sanitary domain - with a multiplication of new offers, not always adjusted to specific identified needs, while health care services were on the same time under-used. Our observations plead against emergency responses in crisis situations and for reflecting on the measures to be put in place rather than to "act" them.

[The gender paradox in suicide : some explanations and much uncertainty]. / Le paradoxe du genre dans le suicide : des pistes explicatives et pas mal d'incertitudes.

Men die more by suicide than women, but women attempt suicide more frequently. Gender does indeed shape suicidal ideas and behaviors. Due to differences in the way men express their suffering, men's depression may be underdiagnosed and undertreated. Furthermore, regarding suicidal behaviors, men use more lethal suicide methods than women. Their suicidal process seems also to progress more rapidly, which is probably related to their frequent substance use. Clinicians and researchers should consider these differences in their approach, without reducing men and women to their gender.

Le paradoxe du genre dans le suicide renvoie au fait que les hommes se suicident plus que les femmes, alors que ces dernières font plus de tentatives de suicide. Ce phénomène s'expliquerait par l'influence du genre dans ce qui détermine les idées et les conduites suicidaires. Des manifestations différentes de la souffrance psychologique pourraient d'abord conduire à un défaut de reconnaissance des dépressions masculines. Ensuite, au niveau même des comportements suicidaires, les hommes optent pour des moyens plus létaux et l'évolution de leur processus suicidaire est plus rapide, entre autres en lien avec le fait qu'ils consomment plus fréquemment des substances. Les cliniciens et les chercheurs devraient prendre ces différences en considération dans leur approche, sans réduire hommes et femmes à leur appartenance de genre.

[Physicians, their practice, and the institution : to adapt or to situate oneself ?] / Le médecin, sa clinique et l'institution : s'adapter ou se situer ?

The context of the clinical encounter, and more generally of the practice of medicine, has effects on physicians. For example, it shapes their opinions, discourses, and ultimately their behaviors. The context may also directly impact physicians, sometimes affecting their physical and mental health. Numerous interventions, provided within and outside the institution, are targeting these effects. The question we raise in this article is: should physicians adapt to, or should they rather situate themselves within, their context. This question leads us to discuss reflexivity and reflexivity training.

Le contexte du médecin, « ce qui entoure ¼ la rencontre clinique et, plus globalement, sa pratique, produit des effets sur lui, par exemple en orientant, déterminant et modelant ses opinions, ses discours et sa conduite. Ces effets peuvent se révéler délétères et atteindre les médecins dans leur santé physique et psychique. De nombreuses interventions et formations sont aujourd'hui ciblées sur ces effets et proposées dans et hors institution. La question que nous posons dans cet article est de savoir si les médecins doivent apprendre à s'adapter à leur contexte ou, plutôt, à s'y situer. Cela nous amène à traiter du processus de réflexivité et des formations à la réflexivité.

[The physician, the clinical practice, and the institution: the suicidal patient]. / Le médecin, sa clinique et l'institution: le cas du patient suicidaire.

Patients and their clinical predicaments have an impact on clinicians (that psychoanalysis frames as countertransference), but also on medical institutions. Suicidal patients provide a potent illustration of such phenomena. At the individual level, they evoke intense, often negative affective reactions. At the institutional level, they are also « difficult ¼ patients, who often do not conform to the classical, « expected ¼ sick role. This can result in policies too focused on risk assessment and strict procedures, potentially detrimental to proper care. To prevent such defensive attitudes, institutions should provide clinicians an environment in which they are able to work through their relationships with patients, but also with the medical profession and institutions.

Parallèlement à ce qu'ils éveillent chez les cliniciens ­ les psychanalystes parlent de contre-transfert ­, les patients ont des effets sur l'institution. La suicidalité en fournit un bon exemple. Au niveau individuel, la rencontre avec les patients suicidaires suscite des affects intenses et souvent négatifs. Au niveau institutionnel, ces patients, difficiles, rappellent les suicides passés et leurs effets traumatiques; ils peuvent être ambivalents vis-à-vis des soins et ne se conforment pas au rôle « attendu ¼ des malades. En réaction, on peut observer des mouvements délétères, comme le développement de procédures trop focalisées sur l'évaluation du risque. Pour les prévenir, l'institution doit offrir aux cliniciens qui la font et la soignent un cadre pour penser leur relation aux patients, au métier et à l'institution elle-même.

[ASSIP: A new therapy following suicide attempt]. / ASSIP : nouvelle modalité thérapeutique après un geste suicidaire.

Although patients attempting suicide represent a highly vulnerable population, are often reluctant to care and at high risk of repetition, no specific therapy exist for them in French-speaking Switzerland. ASSIP® (Attempted Suicide Short Intervention Program) fills in this gap. It is a short therapy developed in Bern and being currently implemented in French-speaking Switzerland with the support of the Foundation « Promotion santé suisse ¼ (Swiss health care promotion). ASSIP® intervention is patient-centered and based on a narrative and behavioral approach and reduces suicide reattempts. It aims to jointly understand patient's suicidal process and to help him/her developing personal strategies to prevent repetition and manage future suicidal crisis.

En Suisse romande, les personnes ayant fait une tentative de suicide n'ont actuellement pas de prise en charge thérapeutique spécifique, alors qu'il s'agit d'une population particulièrement vulnérable, souvent réticente aux soins et présentant un risque élevé de récidive. Pour combler ce manque, une thérapie brève en quatre séances élaborée à Berne (l'Attempted Suicide Short Intervention Program (ASSIP)) est en cours d'implantation avec le soutien de la fondation Promotion santé suisse. Proposée en parallèle du traitement habituel, l'ASSIP est basée sur une approche narrative et cognitivocomportementale, centrée sur la personne. Efficace pour prévenir la récidive suicidaire, cette intervention vise à mieux comprendre le processus suicidaire et à permettre aux patients de développer des ressources afin de prévenir et d'agir lors d'une prochaine crise suicidaire.

Frequency of Abnormal Glucose Tolerance Test Suggestive of Dumping Syndrome Following Oesophageal Atresia Repair.

OBJECTIVES: Dumping syndrome (DS) is mostly described as a complication of antireflux surgery in oesophageal atresia (OA) but we previously reported 2 cases of DS before any other surgery in infants operated at birth for OA. The objectives of the present study were to assess the prevalence of abnormal oral glucose tolerance test (OGTT) at 3 months of age in infants operated at birth with type C OA, to describe symptoms and clinical features, and to assess risk factors in infants presenting with abnormal OGTT suggestive of DS. METHODS: A prospective case series study including infants with type C OA without fundoplication, born between 2013 and 2016 in 8 centres was conducted. An OGTT was performed between 2.5 and 3.5 months. Abnormal OGTT was defined as early hyperglycaemia (>1.8 g/L until 30 minutes; >1.7 g/L between 30 minutes and 2 hours; and >1.4 g/L between 2 and 3 hours) and/or late hypoglycaemia (<0.6 g/L after 2 hours). RESULTS: Eleven of the 38 OGTT (29%) showed abnormalities. None of the patients' demographics (birth weight, sex, prematurity, associated malformation, use of enteral nutrition) or conditions of the surgery tested was associated with abnormal OGTT. No clinical sign was specific for it. CONCLUSIONS: DS should be considered in every infant operated at birth for OA presenting with digestive symptoms. No risk factor was predictive for abnormal OGTT. An OGTT to screen for potential DS around 3 months of age should be considered in infants born with EA. CLINICAL TRIAL NAME AND REGISTRATION NUMBER: DUMPING NCT02525705.

Bronchopulmonary and vascular anomalies are frequent in children with oesophageal atresia.

AIM: Oesophageal atresia is frequently associated with other malformations, and our aim was to use computed tomography (CT) to explore intrathoracic malformations in patients with this condition. METHOD: This was retrospective study of children aged 0-16 with oesophageal atresia who were born in 1996-2013 and followed up at the French reference centre for rare oesophageal diseases at the University of Lille. Computed tomography scans were available for 48 of the 234 patients during follow-up visits, and these were reviewed by a thoracic radiologist. RESULTS: More than two-thirds of the scans were performed to explore persistent respiratory symptoms. We found that six patients had a pulmonary malformations: four lobar agenesis, one right pulmonary aplasia and one congenital cystic adenomatoid malformation. Computed tomography enabled us to diagnose unexpected thoracic malformations in 16 patients: four lobar agenesis, six arteria lusoria, five persistent left superior vena cava and one partial anomalous pulmonary venous return. It also confirmed the diagnoses of suspected malformations in five patients: one congenital cystic adenomatoid malformation, one pulmonary hypoplasia, two right-sided aortic arches and one communicating bronchopulmonary foregut malformation. CONCLUSION: Intrathoracic anomalies were frequently associated with oesophageal atresia, and contrast-enhanced chest CT scans should be performed on patients with persistent respiratory symptoms.

[Psychiatry in the time of pandemic†: forging new ways without getting lost]. / La psychiatrie face à la pandémie†: se réinventer sans se perdre.

Coronavirus pandemic challenges mental health care providers in different ways. At an individual level, they have to adapt their clinical practice and consider specific issues of teleconsultations to address patient's needs. At a population level, dedicated interventions (e.g. hotlines, health professionals' support) have to strike a balance between «â€…pathologizing ¼ people's reactions and trivializing the psychological effects of a pandemic. Finally, psychiatric leaders must be able to advise decision-makers on mental-health policy and communication.

La pandémie de coronavirus oblige les soignants en santé mentale à réinventer leur manière de travailler et à penser de nouveaux cadres thérapeutiques, les patients réagissant de manière singulière à cette situation extraordinaire. Sur un plan populationnel, les interventions envisagées (e.g. hotlines, soutien aux professionnels et aux équipes) doivent trouver un équilibre entre une «â€…psychiatrisation ¼ des vécus d'ordre existentiel et une banalisation des effets psychologiques d'une pandémie. Sur les plans institutionnel et politique, la psychiatrie peut conseiller les décideurs quant aux impacts psychologiques et à la communication.

Predictors of the Performance of Early Antireflux Surgery in Esophageal Atresia.

OBJECTIVE: To identify predictors of and factors associated with the performance of antireflux surgery during the first year of life in children born with esophageal atresia. STUDY DESIGN: All patients were included in a French registry for esophageal atresia. All 38 multidisciplinary French centers completed questionnaires about perinatal characteristics and one-year outcome for children born with esophageal atresia. RESULTS: Of 835 infants with esophageal atresia born in France from 2010 to 2014, 682 patients, excluding those with long-gap esophageal atresia, were included. Three patients had type I, 669 had type III, and 10 had type IV esophageal atresia. Fifty-three children (7.8%) received fundoplication during the first year of life. The median age at the time of the end-to-end esophageal anastomosis was 1.1 day (range 0-15). Multivariate analysis identified three perioperative factors that predicted the need for early antireflux surgery: anastomotic tension (P = .004), associated malformations (P = .019), and low birth weight (P = .018). Six other factors, measured during the first year of life, were associated with the need for antireflux surgery: gastroesophageal reflux (P < .001), anastomotic stricture (P < .001), gastrostomy (P < .001), acute life-threatening event (P = .002), respiratory complications (P = .045), and poor nutritional status (P < .001). CONCLUSIONS: Gastroesophageal reflux disease, low birth weight, poor nutrition, and surgical anastomosis difficulties predicted the performance of antireflux surgery in the first year of life in infants with esophageal atresia.