Vegetarianism and eating disorders: The subjective experience of healthcare professionals.

Vegetarianism is growing dramatically among adolescents and young adults. Professionals specialized in eating disorders (ED) may routinely face patients adhering to these popular vegetarian practices. This qualitative study aimed to investigate healthcare professionals' subjective experience of vegetarianism in ED patients. Interviews of practitioners specialized in ED, recruited from the French federation of anorexia and bulimia (FFAB), were conducted using a semi-structured guide. We reached data saturation. Thematic analysis was used to identify and analyze patterns of meaning in the dataset. Eighteen professionals (dieticians, physician-nutritionists, and a psychiatrist) with private or institutional practices were interviewed. Three meta-themes emerged from our thematic analysis: (1) heterogeneous perceptions of vegetarianism among healthcare professionals, (2) diverse nutritional care practices, (3) factors influencing professionals' nutritional strategies and approaches. This original qualitative and exploratory study reported vegetarianism is a fast-growing phenomenon observed in a majority of adolescent patients with anorexia nervosa, with various underlying motivations reported. In all cases, the nature of the timing and relation between the vegetarian practices and the ED should be carefully assessed, using specific tools. Because of the ethical dimension of this issue and the risk of professional bias, institutional policy based on specific practice guidelines, to be developed, are strongly encouraged.

Disclosure of sexual abuse by adolescents treated in a psychiatry department.

OBJECTIVES: The aim of the study is to describe the population of adolescents who have disclosed sexual abuse to a health professional during their care in a psychiatric department. We also want to discuss the circumstances that enable adolescents to make this disclosure. METHODS: This single-center retrospective observational study is based on the mandatory reports (n=139) sent by a Paris adolescent psychiatry department between 2005 and 2021 after patients disclosed previous sexual abuse. R® (3.6.1) and RStudio® (1.2.5001) software were used for statistical analysis. RESULTS: Girls accounted for almost all the adolescents who disclosed (95.7%). First abuse occurred around the age of 12 years and was first disclosed to a health professional a mean of 3.5 years later; 66 (47.5%) patients were admitted for inpatient care during their follow-up. The most common diagnoses were depression, eating disorders, posttraumatic stress disorders, and other anxiety disorders. Before disclosing to a health professional, most of these adolescents had already talked about it, mainly to a family member (69.8%) or peers (24.7%). CONCLUSION: This is the first study in France on the reporting of sexual abuse after its disclosure by adolescents being treated in a psychiatry unit. Our results show that child sexual abuse is rarely reported and that health care professionals are far from being the first recipients of these disclosures. We recommend routine screening for sexual abuse in adolescent psychiatry units, improved training for staff receiving these disclosures, and consideration of how best to coordinate medical, social, and legal services for these adolescents.

[Ethical considerations for children living with their imprisoned mothers]. / Réflexions éthiques autour des enfants vivant auprès de leurs mères incarcérées.

In France, pregnant women or women with children under the age of 18 months, and in exceptional cases 24 months, can serve their prison sentences in specially equipped nurseries or mother-child cells. This situation is likely to have a negative impact on the child's health, and on the quality of the bond with the mother over the longer or shorter term. The benefits of maintaining this bond are indisputable, whatever the setting. Improvements to this system could be considered and implemented.

How parents experience their adolescent's disclosure of previous sexual abuse: a qualitative study.

INTRODUCTION: Parents whom adolescents disclose sexual abuse face both a personal traumatic experience, and the need to support their child who is going through a grueling period and needs them. Many quantitative studies exploring the psychological impact of disclosure on parents have been conducted, but few have used qualitative methods. The objective of this study is to explore parents' experiences of their adolescent's disclosure of sexual abuse during psychiatric care, identify the possible beneficial factors and shortcomings, share this knowledge, and improve interventions for these families. METHODS: We conducted semi structured interviews with parents whose children disclosed sexual abuse during their psychiatric care in Paris and analyzed these interviews using a phenomenological framework (interpretative phenomenological analysis). RESULTS: This study analyzed 13 semi structured interviews of 9 mothers and 4 fathers whose children were then aged 14 to 17 years. Qualitative analysis uncovered three themes: (1) Parents: alerts and search for support; (2) Between parents and adolescents: a disruption in relationships linked to the disclosure and its legal consequences; (3) Disclosure at the family level: the possible reactivation of a traumatic past and the search for a new equilibrium. CONCLUSIONS: Considering the parental experience is essential in caring for adolescent patients after they disclose sexual abuse. The need for parental or family psychological support should be systematically assessed. Possible resurgence of parental trauma requires psychiatrists' careful consideration.

Evaluation of the rapid implementation of telehealth during the COVID-19 pandemic: a qualitative study among adolescents and their parents.

The Coronavirus Disease 2019 (COVID-19) pandemic catalysed an abrupt explosion in the use telepsychiatry for the delivery of mental health services. We aimed to explore the experience of telemedicine use during this period among adolescent outpatients and inpatients and their parents. This qualitative study took place in a French adolescent medicine and psychiatry department during the first lockdown. Data collection by purposive sampling continued until we reached theoretical sufficiency. The interviews were analysed by applying Interpretative Phenomenological Analysis which is based on an iterative, inductive process. It included 20 participants: 10 adolescents and 10 parents. The analysis showed three themes: (1) facilitators of a switch from face-to-face to tele-consultation: (a) the context of health emergency, (b) the integration of parents in the treatment, (c) the choice between telephone or video consultation; (2) distance from the therapist's gaze and its consequences: (a) an obstacle to decrypting clinical nonverbal communication, (b) effectiveness depends on the severity of the adolescent's symptoms, (c) and on the previous quality of the therapeutic relationship; (3) awareness of the value of the face-to-face therapeutic space. In the post-COVID era, practitioners would benefit from combining both approaches, face-to-face and remote, based on the quality of the therapeutic alliance, the pathology, the parents' availability for in-person participation, and the patient's age. Future quantitative research will also be necessary to establish the extent to which the experiences described by the participants in this study reflect those of a broader population.

Somatic symptoms in school refusal: a qualitative study among children, adolescents, and their parents during the COVID-19 pandemic.

School refusal (SR) is commonly associated with somatic symptoms that are temporally related to school attendance. Abdominal pain, headache, vomiting, and musculoskeletal pain are frequently encountered and are usually not caused by a physical disease. School refusers, parents and health care workers are often puzzled by these impairing symptoms. In this qualitative study, we assessed somatic symptoms in a population encompassing both school refusers and their parents. We aimed at better understanding experiences and strategies in the management of these debilitating symptoms, while also investigating the journey of these symptoms and their behavioral consequences on the said population. We conducted qualitative interviews both within an Integrated Youth Health Care Unit in Paris and through a French parent-led support group improving care for school refusers. We interviewed 19 young persons with SR (aged 6-21 years old) and 20 parents. Using the Grounded Theory, three themes were identified: (1) somatic symptoms' journey in four phases (emergence, coping, crisis, and disappearance in the context of school dropout); (2) their deconstruction, indicating the patients' emotional state; and (3) their management through self-care practices as well as increased emotional and body awareness. Some parents, who could portray similar symptoms at a younger age, mentioned familial pattern of heightened emotional and sensorial sensitivity as a possible cause. Findings suggested that somatic symptoms in SR offer an insight into the patients' emotional state. We recommend that psychotherapies targeting somatic symptoms could be further assessed in SR, along with educational content aimed at increasing emotional literacy in schools and health care settings.

Experiences of French medical students during their clerkship in adolescent psychiatry: a qualitative study.

The epidemiology of adolescent psychiatric disorders and the relational complexity of their management make exposure to adolescent psychiatry essential during medical school. However, some clinical particularities can complicate the students' learning experiences. Our work aimed to explore the experience of being a medical student during clerkships in adolescent psychiatry. Following the Interpretative Phenomenological Analysis qualitative approach, 20 semi-structured face-to-face interviews were conducted with medical students at the end of their clerkship in adolescent psychiatry. Three super-ordered themes emerged to describe their experience: in-depth self-exploration calling on emotions, thoughts and experiences; changes in the view of adolescent mental health; better understanding of the role and meaning of adolescent psychiatric care and how to approach it. Identification between students and patients could result from time-related factors (the end of adolescent brain remodeling, long, demanding studies, and financial and material dependence). In addition, the predominant use of non-analytical clinical reasoning processes-less valued in the rest of the graduate curriculum-poses a challenge for students. Indeed, for a student to find his or her place in adolescent psychiatry requires the student to reinvent him or herself, because the codes are different (no gown, less well-defined tasks, etc.). Finally, the excess prevalence of mental disorders among medical students requires increased vigilance on the part of tutors. For all these reasons, close, attentive tutoring seems essential to support students, while these clerkships afford a real opportunity for students to broaden their interpersonal skills.

The Cultural Hybridization of Mothering in French Prison Nurseries: A Qualitative Study.

In France, women can be incarcerated during pregnancy and can keep their babies with them in prison up to the age of 18 months. The small number of nurseries in France and their unequal geographic distribution as well as the high percentage of foreign prisoners often result in women's isolation from their usual cultural environment. Family members and cultural community play a crucial role in the process of mothering. The aim of this study is to explore through these mothers' narratives how they experience the cultural aspects of this process in the prison environment. We conducted semi-structured interviews to collect the experience of 25 mothers and 5 pregnant women in 13 different prison nurseries in France and used interpretative phenomenological analysis to explore the data. Four different themes emerged: prison: repression of cultural practices, prison: a culture of its own, loss of traditional culture, and cultural hybridization. The specific environmental architecture and operating rules in prison nurseries may induce acute repression regarding cultural ways of mothering. Considering both cultural permeability specific to the peripartum period during which women tend to more easily embrace cultural aspects from their environment, and family distance which restrains cultural transmission, these mothers gather multiple factors of vulnerability for full prisonization, as a form of forced assimilation to prison culture. But a sort of specific hybrid prison culture around motherhood seems to emerge instead, in a process similar to creolization.

[Taking care of an unaccompanied minor's body at the Maison des adolescents]. / Prendre en charge le corps et son histoire, parcours d'une mineure non accompagnée à la Maison des adolescents.

The care of unaccompanied young exiles in public health care facilities for adolescents often requires teams to adapt their capacities for institutional containment. We describe the case of a 16 year old female migrant adolescent, whose follow-up occurred at the Maison des adolescents of the Cochin Hospital, with several healthcare workers involved. The healthcare team had to reflect on the meaning of her somatic symptoms and why the referring adults were so worried (such as fear of death). We describe how we articulated somatic and psychological care for this adolescent girl living in a precarious situation.

The Process of Becoming a Mother in French Prison Nurseries: A Qualitative Study.

BACKGROUND: Many variables can influence the process of motherhood, including environmental precarity and personal adversity. One about which little is known is the impact of incarceration on women during or after pregnancy. In France, pregnant women or those with children up to 18 months old can be incarcerated with their child in specific units called nurseries. We sought to explore incarcerated women's experience of motherhood in prison environments and its potential consequences on the construction of their identity as mothers. METHOD: We conducted semi-structured interviews to collect the experience of the process of motherhood among 25 mothers and 5 pregnant women in 13 different prison nurseries in France and used interpretative phenomenological analysis to explore the data. RESULTS: Four different themes emerged: prison conflates their status as inmates and as mothers; it limits their freedom as mothers; it disrupts their family structure; and motherhood may help distinguish them from other inmates. CONCLUSION: Incarceration of pregnant women or young mothers in prison nurseries might disrupt the process involved in becoming mothers, causing their identities as prisoners to englobe their identities as mothers and resulting in inappropriate parenting support by prison staff. A professional specialized in peripartum issues should help each woman disentangle her identity as inmate and mother and enable her placement at the facility best adapted to her individual needs as a mother. In any case, if prison must continue to be possible, it must always be a last alternative for women with young children.

Migrant adolescents' experience of depression as they, their parents, and their health-care professionals describe it: a systematic review and qualitative meta-synthesis.

Migrant youth are vulnerable and face a risk of internalised disorders such as depression. This qualitative meta-synthesis explores migrant adolescents' experience of depression. 14 studies (7 qualitative studies and 7 case reports) were selected after a systematic search of PubMed, Embase, Scopus and PsycInfo. Their quality was assessed with the Critical Appraisal Tool (CASP) for qualitative studies and the Joanna Briggs Institute (JBI) checklist for case reports. The analysis identified six themes describing the experience of depression among migrant adolescents: (1) the vulnerability factors underlying depressive distress, before, during and after migration; (2) the subjective experience of depression, combining symptoms associated with a form of depression common in the West with symptoms more common in other cultures; (3) two types of aetiological hypotheses to make sense of their distress; (4) attitudes adopted in response to distress; (5) experience of care, especially reasons discouraging investment in care; and (6) impairment of identity construction by breaks in cultural transmission and intergenerational conflicts. The threat of losing their connections both at the interpersonal (connection to family, peers and community) and intrapsychic levels (construction of identity) is inherently linked to migrant adolescents' experience of depression. We propose to adapt Brandenberger's 3C model (communication, continuity of care, and confidence) for the care of young migrants to promote a therapeutic alliance, foster construction of a coherent bicultural identity, and support the family.

Adolescent attendance at transcultural psychotherapy: a retrospective cohort study.

Migrant adolescents in therapy for psychological problems are at risk of poor attendance or even of dropping out. Transcultural psychotherapy has been developed in France to take cultural diversity into account in psychological treatment and to deal with the specific difficulties encountered in the psychotherapeutic treatment of this population. This study aims to assess adolescents' attendance rates to this form of psychotherapy and to explore the association of these rates with demographic, cultural, and clinical variables. We conducted a retrospective clinical cohort study of 148 adolescents aged from 11 to 20 years treated between 2008 and 2018 at two transcultural psychotherapy centers in Paris. Statistical analyses tested demographic, cultural, and clinical hypotheses. The main result was the high attendance rate at transcultural psychotherapy sessions among adolescents (77.8%). Attendance rates were not associated with age, gender, family size, generation of migration, or cultural area of origin, but were significantly linked to support in therapy, specifically, the presence at the first transcultural psychotherapy session of the first-line therapist, an interpreter, or both. Transcultural psychotherapy appears to be an effective method for addressing the complex symptoms experienced by migrant adolescents. Better attendance at sessions is statistically significantly associated with factors favoring a therapeutic alliance, specifically, the presence of the first-line therapist or an interpreter in TPT sessions and the existence of support from a social worker. The holistic approach of transcultural psychotherapy to adolescent care may explain the high attendance rates observed.

When refeeding is not enough: severe and prolonged pancytopenia in an adolescent with anorexia nervosa.

A 15-year-old female patient with anorexia nervosa presented an unusually prolonged and severe episode of pancytopenia with severe thrombopenia and severe leucopenia. Despite effective refeeding, active specialized interventions were necessary. Upon admission, the patient presented with severe and symptomatic thrombopenia, severe neutropenia and gelatinous marrow transformation. In addition to refeeding, active interventions such as platelet transfusion and granulocyte-colony stimulating factor were successful to manage the patient's complications. The etiological search for pancytopenia was negative. The patient's prolonged starvation was probably a key factor. Medical history, clinical presentation, evolution, and biological data including bone marrow aspiration results are presented. Management of cytopenia and of their complications in a context of severe starvation is discussed in regard of existing literature. A simple monitoring attitude may prove insufficient in cases of severe pancytopenia in anorexia nervosa.Level of evidence V, descriptive study.

[The disclosure of sexual violence by adolescents: clinical and therapeutic complexity]. / Complexités face à la révélation de violences sexuelles par des adolescents.

Despite the frequency and traumatic impact of sexual violence, very few victims allow themselves to speak. Two clinical cases allow us to discuss the modalities of support for adolescents who reveal, during their psychiatric follow-up, that they have been victims of such violence.

[Together in the face of extreme violence: accompanying families after a traumatic event]. / Accompagner les familles après un événement traumatique.

After a traumatic event, families can also be impacted at different levels and require post-immediate or longer-term care. The adaptation of these family care procedures carried out following the attacks of 2015-2016 in France, based on existing clinical arrangements, in a child psychiatry service associated with a medical-psychological emergency unit, is discussed via two clinical examples. These different modalities of follow-up, a family debriefing and a situation of mourning associated with a trauma insist on the necessity to consider the temporality of the follow-up, the use of different theoretical tools, as well as the importance given to rituals and family skills hard hit by the traumatic event.

[A patient education program for adolescents with anorexia nervosa]. / Un programme d'éducation thérapeutique pour adolescents souffrant d'anorexie mentale.

Patient education program (PEP) aims to help the patient acquire the skills necessary to manage a chronic disease. A multidisciplinary TPE program for adolescents with anorexia nervosa was developed in a daycare hospital setting. This qualitative study, exploring the experience of the caregivers involved in this program, reports the benefits but more so the difficulties linked to the clinical specificities of anorexia nervosa, as well as the numerous requirements, constraints and necessary adjustments linked to this innovative practice.

[Medical termination of pregnancy for maternal psychosocial distress]. / L'interruption médicale de grossesse pour détresse maternelle psychosociale.

Medical termination of pregnancy when decided for maternal psychosocial distress is a new issue facing maternity field teams. Multidisciplinary work is required, as well as respect for the patients' temporality. The decision is collegial, estimating the least traumatic impact possible for them over the long term. The ethical principles of beneficence and non-maleficence guide the work of the team and the evaluation of the psychiatrist in this context.

[A case of long form Covid-19 reported by a suffering teenager]. / Un cas de forme longue de la Covid-19 rapporté par une adolescente en souffrance.

Long-term Covid-19 is now part of our lives and can be questioned by adolescents and their families when faced with long- lasting and unexplained symptoms. This is the case of Alice, a 16-year-old teenager treated at the Cochin Hospital's adolescent centre, who presents digestive disorders and strange body sensations mas-king anxiety-depressive affects.

[Place of the father in the transmission of trauma from mother to baby in a migratory]. / Place du père en contexte migratoire dans la transmission du trauma de la mère au bébé.

Paternal involvement impacts the relationship between mother and child and protects the transmission of the traumatic experience in a migratory context. A study was conducted in France with mother-child dyads in which the women were exposed to traumatic events. It identified three themes around the metatheme of the father's place: the husband's function as moral support during migration, his cultural function as a relay for his wife to the child, and the maintenance of the bond despite his physical absence.

A Systematic Review of Somatic Symptoms in School Refusal.

OBJECTIVE: School refusers often display somatic symptoms that are temporally related to school attendance. The aim of this systematic review is to summarize characteristics and causes of somatic symptoms and their management in the context of school refusal. Findings of this review may help clinicians in their daily practice. METHODS: PubMed and PsycINFO databases were systematically searched (according to PRISMA guidelines) for articles mentioning somatic symptoms in school refusal by May 2020. Among 1025 identified studies, 148 were included. RESULTS: Unspecific somatic symptoms were frequently the first complaints in school refusal. Abdominal pain, headache, nausea, vomiting, muscular or joint ache, diarrhea, dizziness, fatigue, and palpitation were the most commonly encountered symptoms and were usually not accounted for by an identifiable physical disease. Anxiety was the most recurrent etiology found, but physicians' lack of awareness about psychological comorbidities often delayed psychological/psychiatric referral. Successful therapies consisted of dialectical behavior therapy, anxiety management through relaxation/breathing training, and ignoring the somatic symptoms. CONCLUSIONS: Somatic symptoms in school refusal are frequent but poorly understood. Their management could include interventions targeting anxiety, psychotherapies such as emotional awareness and expression therapy, third-wave behavioral therapies, and psychoeducation. A multidisciplinary approach through strengthened collaboration between school staff, physicians, and psychologists/psychiatrists is needed to improve well-being in children who experience somatic symptoms as related to school avoidance.