[Validation of a French version of the 16-item Prodromal Questionnaire (fPQ16) in adolescents and young adults seeking help]. / Validation d'une version française du 16-items Prodromal Questionnaire (fPQ16) chez des adolescents et jeunes adultes consultant en psychiatrie.

INTRODUCTION: The duration of untreated psychosis has been largely associated with poor outcomes in psychosis. Actual diagnostic tools may be used by very specialized teams and need sustained evaluation. We present a French version of a self-report questionnaire: the 16-item Prodromal Questionnaire (fPQ16). Our objective was to evaluate its predictive value for an ultra-high-risk state (UHR) or psychosis. The population enrolled was consulting in a young adults and adolescents center in Sainte-Anne hospital, Paris, France. METHODS: PQ16 had first been translated into French and independently back translated and validated by the original authors. Between November 2016 and May 2018, every C'JAAD consulting patient was proposed to fill in the fPQ16. Each patient was next evaluated with the French version of the comprehensive assessment of at-risk mental state (CAARMS), which detects UHR or psychosis. Statistical analysis of fPQ16 concurrent validity was performed using ROC curves. fPQ16 acceptability was studied by four additional questions especially designed for that purpose. RESULTS: One hundred participants were included. Mean age was 19.85years (SD 3.3 y). Fifty-eight percent of patients included were diagnosed with UHR (40%) or psychotic (18%) state after CAARMS evaluation. Mean score at fPQ16 was 5.7 (SD 3.8). Best cut-off score was 4 positive items, with excellent sensibility (91%) and correct specificity (60%). Positive predictive value of fPQ16 was 76%. Area under the curve was 0.85 (P<0.0001). fPQ16 showed good acceptability. DISCUSSION: fPQ16 had good screening performances in our population. Cut-off score was lower than in previous studies, but performances were equal or better. As a well-accepted and short questionnaire, the fPQ16 could be a great screening tool in primary care. A version with 18-items, including two items focused on thought content and disorganization that are missing in PQ16, is under evaluation.

[Psychological processes of stress management and neuroendocrine regulation in incarcerated adolescent offenders: A pilot study]. / Processus psychologiques de gestion du stress et régulation neuroendocrinienne chez les adolescents délinquants en institution fermée : une étude pilote.

BACKGROUND: Adolescence is a stressful period where important biological, psychological and social changes occur. Adolescents are particularly vulnerable during this developmental period and can use various strategies to deal with daily stress, such as substance use or externalizing behaviors. In previous studies, stress in adolescents with externalizing behaviors was often linked to ineffective cognitive coping strategies (i.e., constructive thinking) and overlooking the biological aspects involved in stress management such as neuroendocrine regulation. Indeed, repeated activation of the hypothalamic-pituitary-adrenal (HPA) axis in chronic stress situations may have long-term effects on subsequent cortisol regulation and lead to psychological difficulties. It was also shown that basal cortisol levels are lower in adolescents with externalizing behaviors. This study aims to assess the links between constructive thinking and neuroendocrine regulation in adolescent offenders and their association with externalizing symptoms (e.g., aggression, delinquency, psychopathic traits, substance use). Identifying particular biopsychological patterns can help to better understand stress management in youth with externalizing behaviors and to improve clinical treatments. METHOD: Sixteen adolescent males aged from 12 to 18 years were recruited in an institution for juvenile offenders. Exclusion criteria were insufficient reasoning abilities assessed using the Raven Matrices Test. Regarding psychological dimensions, constructive thinking was assessed through the Constructive thinking inventory (CTI), psychopathic traits through the Youth psychopathic traits inventory (YPI), externalizing behaviors through 30 items (out of 113) and 2 subscales (aggressive behavior and delinquency problems) from the Child behavior checklist-youth self-report (CBCL), and substance use through the Dep-ado. Regarding biological dimensions, cortisol daily secretion and regulation were assessed through saliva samples that were collected during 3 consecutive days (4 samples per day: directly after awakening, at 10 a.m., at 4 a.m., and before going to bed). RESULTS: Adolescent offenders presented maladaptative thinking styles and a particular neuroendocrine regulation in their daily management with stress. In particular, their level of cortisol in the morning was higher than those expected in a general population (20.34 nmol/L while the norm is around 10 nmol/L). They also showed more agressive and delinquent behaviors (CBCL) as well as more psychopathic traits (YPI) than the general population. Moreover, constructive thinking style was associated with personality and behavioral dimensions. Indeed, results indicated positive and significant correlations between categorical thinking style (CTI), psychopathic traits (YPI) (r=0.57, P=0.021) and externalizing behaviors (CBCL) (r=0.55, P=0.028). In other words, the more adolescent offenders used categorical thinking, the more they presented psychopathic traits and externalizing behaviors. With respect to the association between psychological and biological dimensions in stress management, we observed a significant and positive correlation between cortisol regulation and esoteric thinking (r=0.57, P=0.028) and a trend with superstitious thinking (r=0.47, P=0.075). The more adolescent offenders used esoteric and superstitious thinking, the poorer was their cortisol regulation. We also observed a trend between the life style scale of the YPI (i.e., impulsive, irresponsible) and the daily secretion of cortisol (r=0.51; P=0.052) as well as cortisol regulation (r=0.49, P=0.065). The more adolescent offenders presented psychopathic traits, the higher tended to be their daily secretion of cortisol and the poorer their cortisol regulation. Finally, cortisol regulation (r=0.54, P=0.038) and secretion (r=0.73, P=0.002) were significantly correlated with the DEP-Ado score. In other words, a poor cortisol regulation and a high secretion of cortisol seem to be associated with substance use. CONCLUSIONS: Adolescent offenders face an important amount of daily stress and do not always have the appropriate skills to deal with it. Indeed, we know from clinical experience that they often report a sense of hopelessness toward their lack of professional perspectives as well as familial conflicts which can be important stressors in addition to the incarceration in itself. Therefore, treatment aiming to improve psychic elaboration can help these adolescents to make their thinking styles more flexible and use more appropriate ways of coping with stress instead of externalizing behaviors and substance use. Moreover, considering the complex cases of these adolescents and the many changes of caregivers and institutions where they have lived, which can be important stressors as well, professionals working with these youth should be aware of their emotional reactions toward them and try to encourage continuity of care.

Patients' satisfaction with community treatment: a pilot cross-sectional survey adopting multiple perspectives.

ACCESSIBLE SUMMARY: Patients' satisfaction is scarcely studied within the context of community treatment for adolescents. Thus, this study adopts a multiple perspective on patients' satisfaction (including service users as well as staff members). The results highlighted that all informants (patients, foster carers in foster homes and professional caregivers from community treatment teams) perceived the patients to be satisfied, with foster carers reporting the highest patient satisfaction rate. Considering the patient satisfaction rate from multiple perspectives provides complementary understandings. Clinical outcomes and, specifically, a reduction in emotional difficulties were related to patient's satisfaction, but only from the patients' perspective. ABSTRACT: Community treatment (CT) teams in Switzerland provide care to patients who are unable to use regular child and adolescent mental health services (i.e. inpatient and outpatients facilities). No study has considered patients' self-rated satisfaction alongside with staff members' perspectives on patient satisfaction. Thus, adopting a cross-sectional survey design, we collected patients' satisfaction using the Client Satisfaction Questionnaire (CSQ-8), rated by multiple informants (patients, foster carers in foster homes and professional caregivers from CT teams). Professional caregivers assessed clinical outcomes using the Health of the Nation Outcome Scale for Children and Adolescents. The results indicated that all informants were satisfied with the community treatment teams. The satisfaction scores were not correlated across informants; however, the alleviation of emotional symptoms was correlated with patients' satisfaction. This study indicated that the use of a combined approach including the views of service users and professionals gives important complementary information. Finally, in our sample, lower emotional symptoms were linked to enhanced patient satisfaction. This study demonstrated the importance of considering multiple perspectives to obtain the most accurate picture of patients' satisfaction. Second, focusing on the reduction of emotional symptoms might lead to a higher degree of patients' satisfaction.

[Extension of mobile team services to the home: pilot project in the Vaud canton]. / Extension des prestations de type "équipe mobile" aux foyers socio-éducatifs: projet pilote dans le canton de Vaud.

The main objective of this project about mobile team service extension to the socio-educational home of the whole Vaud canton targets to decompartmentalize the socio-educational and youth-psychiatry domains. 64 patient were assessed during this pilot phase (after one-year functioning). In addition, a satisfaction survey was done either at the end of the follow up or at the end of the pilot phase of the project (31.12.2012). This experience was very positive as highlighted by the vast majority of the person involved in the socio-educational and youth-psychiatric domains taking care of youth. A desire of extension of mobile team service to other institutional structure or other situations was expressed.

Quetiapine in adolescents with non-affective psychotic disorders: an open-label trial.

INTRODUCTION: There is a need for more studies on the clinical effectiveness, tolerability and pharmacokinetics of atypical antipsychotics in adolescents with psychotic disorders, as this represents a vulnerable and difficult population to treat. According to recent concerns regarding disabling side effects of antipsychotics, particularly weight gain, further monitoring of their safety profiles is needed. This situation prompted the authors to carry out an investigation on the clinical effectiveness of quetiapine in psychotic adolescents. METHODS: 23 adolescents (13-18 years old) with psychotic disorders participated in a 12-week open label trial, including 6 visits assessing clinical efficacy, tolerability and safety of quetiapine (50-750 mg daily). RESULTS: Adolescents were treated with lower doses compared to adults. Significant decreases in CGI and PANSS total scores were observed after both 4 and 12 weeks of quetiapine treatment compared to baseline. Sedation was the main adverse effect, but medication was generally well tolerated. Irregular compliance, (as assessed by pill counts, a questionnaire and by plasma quetiapine concentration monitoring), and alcohol and/or cannabis consumption were factors identified in this study which add to the difficulty in treating this population. DISCUSSION: The results of the present study help to consolidate evidence of the usefulness of quetiapine as a treatment for adolescents with psychotic disorders. However, this study also highlights the issues encountered in treating this group, including the presence of comorbidities such as drug abuse.

Attentional networks efficiency in preterm children.

Recent studies have reported specific executive and attentional deficits in preterm children. However, the majority of this research has used multidetermined tasks to assess these abilities, and the interpretation of the results lacks an explicit theoretical backdrop to better understand the origin of the difficulties observed. In the present study, we used the Child Attention Network Task (Child ANT; Rueda et al. 2004) to assess the efficiency of the alerting, orienting and executive control networks. We compared the performance of 25 preterm children (gestational age < or = 32 weeks) to 25 full-term children, all between 5(1/2) and 6(1/2) years of age. Results showed that, as compared to full-term children, preterm children were slower on all conditions of the Child ANT and had a specific deficit in executive control abilities. We also observed a significantly higher correlation between the orienting and executive control networks in the preterm group, suggesting less differentiation of these two networks in this population.

The contribution of aging to the understanding of the dimensionality of executive functions.

It has been reported in the literature that executive functions may be fractioned into updating, shifting, and inhibition. The present study aimed to explore whether these executive sub-components can be identified in a more age-heterogeneous sample and see if they are prone to an age-related decline. We tested the performances of 81 individuals aged from 18 to 88 years old in each executive sub-component, working memory, fluid intelligence and processing speed. Correlation analysis revealed only a slight positive relationship between the two updating measures. A linear decrement with age was observed only for two complex executive tests. Tasks indexing working memory, processing speed and fluid intelligence showed a stronger linear decline with age than executive tasks. In conclusion, our results did not replicate the executive structure known from the literature, and revealed that decrement in executive function is not an unavoidable concomitant of aging but rather concerns specific executive tasks.

Asymmetric sensorineural hearing loss in a community-based population.

Asymmetric sensorineural hearing loss (ASNHL) is fairly common, but it can be an indication of retrocochlear pathology. The incidence of acoustic neuroma (AN) has been estimated at 1/100,000; however, the incidence of AN in patients with ASNHL is unknown. The limitation of health care resources challenges otolaryngologists to develop reasonable cost-containment guidelines for the evaluation of patients with ASNHL for the presence of retrocochlear pathology. A 5-year (1990 to 1994) retrospective study of all patients with ASNHL who were evaluated in a community-based general otolaryngology practice was performed. Demographic, historic, and audiologic data and results from ABRs and radiologic studies were summarized. ASNHL was present in 325 patients. Auditory brain stem response tests were performed in 179 patients (55%), and 92% (164 of 179) were normal. Patients with abnormal or inconclusive auditory brain stem responses and patients with severe SNHL were evaluated with radiologic studies (46 patients). Among the 193 patients who had diagnostic studies, 4 were found to have ANs, for a prevalence of 2.1%. The charge of diagnosis per AN was more than $41,000. In summary, a small percentage of patients with ASNHL have retrocochlear pathology, and the charge of diagnosis per AN can be excessive. A cost-containment approach for the evaluation and management of patients with ASNHL is proposed.

Otolaryngologic features of Laurence-Moon-Bardet-Biedl syndrome.

The most common otolaryngologic features associated with LMBBS include SNHL, speech and language disorders, and oral and dental abnormalities. Early otolaryngologic, audiologic, speech pathology, and dental evaluation of these individuals is recommended. This is the first reported case of bifid epiglottis, a rare congenital laryngeal anomaly, found in association with LMBBS. Most patients with bifid epiglottis have additional congenital anomalies, most commonly polysyndactyly. Polysyndactyly is a feature of both LMBBS and bifid epiglottis and may be an early hallmark for the presence of other congenital anomalies.

Tympanostomies with tubes: the parent perspective.

Successful physician-patient encounters satisfy patient and family member needs beyond the effect on the disease process itself. To evaluate that aspect of care in children with chronic and recurrent acute otitis media with effusion, surveys regarding perceptions of health, socioeconomic issues, and other aspects of postoperative status were sent to the parents of 637 children who underwent tympanostomies with tubes in 1994. Three hundred one (47.3%) were returned. Responses included perceptions of improved health (87%), improvement in socioeconomic factors (75%), overall satisfaction with the results of the operation (93%), and willingness to consent to the operation given similar problems in another child (87%). There were no significant differences in responses with regard to patient gender, length of follow-up, or multiple operations. These results suggest that patient and family needs are satisfied by tympanostomies with tubes.

Ketorolac (Toradol) and acute random-pattern skin flap survival in rat.

OBJECTIVE: To assess the efficacy of sustained postoperative intramuscular ketorolac tromethamine (Toradol) at analgesic levels in the augmentation of acute, random-pattern skin flaps in rat. DESIGN: Prospective, randomized, placebo-controlled, animal trial. SETTING: Animal research laboratory, School of Medicine, Oregon Health Sciences University, Portland. SUBJECTS: Forty-four adult male Sprague-Dawley rats (260 to 280 g). INTERVENTIONS: Twenty-two treatment animals underwent modified McFarlane random-pattern skin flaps followed immediately by intramuscular loading doses of ketorolac. Treatment animals were then maintained on a regimen of intramuscular ketorolac using a three times a day dosing schedule for 14 days postoperatively. Twenty-two control animals underwent identical modified McFarlane random-pattern skin flaps and were given equivalent volumes of intramuscular saline on the same dosing schedule for the 14-day treatment period. MAIN OUTCOME MEASURES: Postmortem measurements of skin flap ischemia (expressed as a percentage of total flap surface area) were performed for both treatment and control animals by three independent, non-blinded observers using the acetate tracing technique. Both pooled and individual data were statistically analyzed using personal computer software. RESULTS: Forty-three of the 44 animals successfully completed the experimental trial. One animal in the treatment group died on postoperative day 3 of unknown causes. During the study period, one postoperative hematoma was detected in both the treatment and control groups. The mean percentage of skin flap ischemic necrosis observed in control animals (35.4%) was consistently less than that measured in the treatment group (36.4%). However, the difference in ischemic flap necrosis between control and treatment groups was not statistically significant (P = .6919). CONCLUSIONS: Comparatively high-dose intramuscular ketorolac failed to augment acute, random-pattern skin flap survival in rat when initiated in the immediate postoperative period. Complications of prolonged, intramuscular ketorolac were not observed in this trial. Further studies using preoperative initiation of drug therapy may help to clarify the true efficacy of ketorolac in flap augmentation.