Feedback on a socio-aesthetic program for the benefit of young patients with self-endangerment.

OBJECTIVES: Socio-aesthetics is a practice born in psychiatric departments but has since developed particularly in the field of oncology. For our part, since January 2018, we have initiated an experiment of this type at the Espace Unit of the CHU in Nantes, a unit that takes care of young patients who find themselves in a situation of crisis and endangerment of themselves. METHODS: The qualitative evaluation of the interest of a socio-aesthetic mediation (relaxation modelling, facial care, make-up) with young patients was carried out by a collection of their feelings. RESULTS: Youth who expressed an overall judgment of socio-esthetic mediation appreciated it in 61% of cases. They express their satisfaction with words such as "I liked", "I loved", "I'm happy", "it was too good", "super good" or "great". CONCLUSION: This successful socio-aesthetic therapy practice experiment will continue with a quantitative analysis to demonstrate the relevance of this type of service to psychiatric patients.

[Portrait of an IPA PSM specialising in suicide prevention]. / Portrait d'un IPA PSM spécialisé en prévention du suicide.

Suicide prevention is a major public health issue, both nationally and internationally. The management of suicidal patients leaving emergency departments is crucial to preventing the risk of suicidal recurrence. Advanced practice nurses in psychiatry and mental health can provide real added value thanks to their specialist training, their ability to carry out a comprehensive and detailed clinical assessment, their mastery of medicinal and non-medicinal therapeutic interventions, their skills in coordinating the various players involved in the care pathway, their commitment to prevention and their skills in supporting the development of the skills of care and research teams.

[The place and function of the gender of child psychiatric carers]. / Place et fonction du genre des soignants en pédopsychiatrie.

In a child psychiatry unit, where it is said that men are reassuring and women are mothering, the group experience of carers on the function of their gender in child care was explored. Gender is relevant to institutional care, but creates a divide. Representations focus on fear, sexuality, violence and fragility. Caregivers, ambivalent about neutralising gender, suffer from representations of what it does to children and to the institution.

[Psyperinatal mobile teams: News and prospects]. / Équipes mobiles psypérinatales : actualités et perspectives.

Perinatal psychiatry is now defined in the French Public Health Code as joint parent-baby care. It focuses on parent-baby interactions, the baby's development and the parents' psychological health. "Mobile teams" for joint (parent-baby) care, the very first of which date back to the 1990s, have been developed modestly thanks to the call for perinatal psychiatry projects in 2021 and those for child and adolescent psychiatry since 2019. These mobile units complement full-time outpatient and inpatient joint care units.

[The place of gentleness in joint perinatal psychiatric care]. / Place de la douceur dans les soins conjoints de psychiatrie périnatale.

The complexity and specificity of joint care in perinatal psychiatry call for a rethinking of gentleness. Allowing oneself to make it the object of reflection in its own right means summoning up an essential dimension of welcoming, carrying and meeting the other, which are at the heart of support. Articulating adversity and fragility, creativity and destructiveness, gentleness is a quality, a texture on which a care team can rely from both a clinical and an institutional point of view.

[A framework for the practice of peer support]. / Pour un cadre d'exercice de la pair-aidance.

The concept of peer support is now firmly established in the psychiatric landscape. While taking into account the benefits that this approach brings to patients and teams, it is essential to consider the need to define a framework for the practice of peer support. This framework, which is essential for the development of the practice, will help to avoid overly fragile exposure, which is synonymous with difficulties for peer helpers and their teams.

[The contribution of a mental health patient trainer to carers]. / L'apport d'une patiente-formatrice en santé mentale auprès des soignants.

As peer support becomes more professional, it is becoming increasingly recognised and diversified. When a mental health patient-trainer works with psychiatric carers, the latter gain a better understanding of the patient's point of view. In addition, valuing their experiential knowledge can support peer helpers in their recovery. However, we mustn't forget that these are fragile people and that their past can come back to haunt them if they are not careful. Testimonial.

[Comparative analysis of access to professional peer helpers in mental health and somatic care]. / Analyse comparative des modalités d'accès aux pairs-aidants professionnels en santé mentale et somatique.

Peer health mediators are now part of the psychiatric landscape. Their work has been extended to the medico-social, social and addiction fields. The French National Authority for Health advocates the integration of peers into institutions to support and encourage patients' involvement in their care. Psychiatry has been a forerunner in this deployment. Its example could be useful beyond.

[Joint study of seclusion, mechanical restraint and chemical restraint: Pilot study in three French psychiatric hospitals]. / Étudier conjointement l'isolement, la contention mécanique et la contention chimique : étude pilote dans trois établissements psychiatriques français.

Psychiatric wards that only exceptionally use isolation and mechanical restraint may be suspected of using "chemical restraint". However, in the case of these services, the hypothesis of a reduction in the general level of restraint can also be formulated. Prior to a comprehensive study to test these hypotheses, the current research aims to assess indicators which define high levels of the use of these measures and a relevant sample. The study was conducted in three facilities with 254 hospitalized patients over a week. Five per cent experienced isolation, 2% mechanical restraint, and 13% received high doses of medication (including "as needed" treatments). These figures are below literature data and national averages. Variances exist among centers, with one showing higher percentages for all three measures. While confirming the feasibility of studying these measures together, the study suggests the need for longer observations and continuous evaluation of prescription practices to better reflect yearly isolation and restraint trends. Future studies should involve more centers and include case studies for a nuanced understanding of administration practices in relation to prescriptions.

Learning to observe art to better understand the patients: A pilot study.

OBJECTIVES: We describe an artwork observation training program proposed to the first-year psychiatry residents in the school of medicine of Montpellier-Nîmes (Université de Montpellier). This course aimed at improving the ability to observe, tolerate ambiguity in healthcare, work as a team, communicate, and develop empathy. We also evaluated the impact of this program on the enhancement of emotional and communication skills in a pilot study. MATERIALS AND METHODS: The artwork observation program based on Visual Thinking Strategies consisted of three sessions of ninety minutes involving two groups of eight medical students. First-year volunteer psychiatry residents were recruited. Before the sessions participants completed the Groningen Reflection ability Scale to evaluate reflection skills. Then, all the participants examined paintings and drawings of the Atger collection, were encouraged to observe carefully, and to engage in active group discussion by means of a structured questioning. Following the session, participants responded to a short survey to assess potential improvement of socio-emotional and communication skills. RESULTS: Fifteen psychiatry residents participated in the pilot study, eight were males. The median age was twenty-five years. The artwork observation program was well accepted by the participants. All the respondents reported improvement of emotional and communication skills, except regarding three empathy items, including the ability to feel the suffering of others which was increased only for 62% of respondents. DISCUSSION: Our program relying on Visual Thinking Strategies may improve the ability to observe carefully, to perceive the mental states of others, and to tolerate uncertainty. Training of such skills may encourage the adoption of self-reflective attitudes. CONCLUSIONS: Such an artistic innovative program should be extended to undergraduate students in medical curriculum.

[Initiation to patient partnership in mental health and psychiatry from initial training onwards]. / Initiation dès la formation initiale au partenariat patient en santé mentale et psychiatrie.

Introducing patient partnership in mental health and psychiatry to initial training is an innovative way of promoting recovery, while at the same time highlighting the undeniable contribution of peer support within healthcare teams, in order to accompany the people concerned. This is why Croix-Rouge Compétence Auvergne-Rhône-Alpes is developing a specific training program for trainees.

[Clinical reflexes in the face of an atypical neuropsychiatric picture]. / Réflexes cliniques devant un tableau neuropsychiatrique atypique.

A 59-year-old man who had been presenting with a variety of neuropsychiatric symptoms for several weeks. Despite repeated visits to somatic emergencies, as well as a thorough work-up including complementary examinations and specialist opinions, no organic diagnosis was established. The patient was treated symptomatically with neuroleptics and benzodiazepines, which led to a significant improvement in symptoms.

The Role of Dietary Patterns and Nutritional Supplements in the Management of Mental Disorders in Children and Adolescents: An Umbrella Review of Meta-Analyses: Le rôle des habitudes alimentaires et des suppléments nutritionnels dans la prise en charge des troubles mentaux chez les enfants et les adolescents : une méta-revue de méta-analyses.

OBJECTIVE: In recent years, the relationship between nutrition and mental health has gained considerable interest. We identified, synthesized, and appraised all meta--analyses of randomized controlled trials (RCTs) and observational studies reporting on the efficacy of dietary patterns and nutrient supplements in the prevention and treatment of mental disorders in children and adolescents. METHODS: Systematic research in MEDLINE, PsycINFO, Scopus, and Cochrane Database of Systematic Reviews was completed on 8 January 2024. RESULTS: Our research found 24 meta-analyses: 14 on RCTs, 8 on observational studies, and 2 combining both. Emerging evidence suggests that omega-3, in particular eicosapentaenoic acid, and Vitamin D may have adjunctive benefits in the treatment of attention deficit hyperactivity disorder (ADHD), while no evidence was found for autism spectrum disorder (ASD). Observational data also indicated that prenatal folic acid supplementation (>400 µg daily) was associated with a reduced risk of ASD in offspring. In terms of dietary habits, several meta-analyses of observational data revealed that healthy dietary patterns (rich in fruits, vegetables, and fibre, low in saturated fats) during the prenatal period, childhood, and adolescence were linked to a significantly reduced risk of internalizing disorders and externalizing disorders. Conversely, unhealthy dietary habits (high in sugars, saturated animal fats, and industrial foods, low in fruits, vegetables, and fibre) are associated with an elevated risk of these mental health issues. However, the number of available studies on dietary interventions for the treatment of depression, ASD, and ADHD was limited, and the results obtained were either nonsignificant or contradictory. CONCLUSION: Our findings emphasize the need to establish clear causal relationships between dietary habits and the risk of mental illness in children and adolescents. Moreover, further investigation of the benefits observed with some nutrient supplements (such as omega-3 and vitamin D for ADHD) through larger-scale RCTs is imperative to establish more robust conclusions.

We investigated the link between nutrition and mental health in children and adolescents through a meta-review of 24 relevant meta-analyses. Emerging evidence suggests potential benefits of Omega-3 and Vitamin D in treating ADHD, while no evidence supports their effectiveness in ASD. Observational data also indicate that prenatal folic acid supplementation may lower ASD risk. Healthy dietary patterns reduce the risk of internalizing and externalizing disorders, whereas unhealthy habits elevate the risk. Limited studies on dietary interventions for depression, ASD, and ADHD provide inconclusive results. In summary, our results emphasize the need to clearly understand the cause-and-effect relationships between dietary habits and mental health risks in young individuals. Larger-scale randomized controlled trials are essential for confirming the observed benefits of nutrient supplements such as omega-3 and vitamin D in treating ADHD and for forming more reliable conclusions.

[The new nursing professions in psychiatry: One man's dream, another man's nightmare?] / Les nouvelles professions infirmières en psychiatrie, rêve des uns, cauchemar des autres ?

The deployment of case management and advanced nursing practice is shaking up the roles of the various professionals on mental health teams, and the usual organization of care in psychiatry. These changes can be perceived as either positive or worrying, depending on each individual's role and position. For the past 3 years, the mobile teams of the Centre rive gauche cluster at Le Vinatier hospital have been organized according to the principles of Flexible Assertive Community Treatment, and include an advanced practice nurse (APN) on their staff. The roles of the case manager and the APN have been rethought. A number of measures have facilitated the implementation of these new functions.

[IPA's clinical expertise in the identification and assessment of somatic pain in schizophrenic patients]. / Expertise clinique de l'IPA PSM dans le repérage et l'évaluation de la douleur somatique chez les personnes schizophrènes.

Identifying and assessing somatic pain in people with schizophrenia remains a major public health issue for this vulnerable population. In France, Advanced Practice Nursing is developing, based on a practice built around clinical expertise. How can the clinical expertise of psychiatric and mental health APNs improve the identification and assessment of somatic pain in these patients, and thus help to improve their somatic health?

Programme de soins psychiatriques : Etude de l'expérience de jeunes patients par une méthode qualitative: Psychiatric care program: A qualitative study of the experience of young patients.

OBJECTIVE: Ambulatory care without consent is widely used, but it is controversial, and its effectiveness has not yet been proven. The patient experience remains largely unstudied in France, particularly that of young patients, yet their adherence to care in the early stages of the disease is complex and has an impact on their prognoses. The aim of this study is to investigate the experience of young patients undergoing a program of care (POC) in order to suggest ways of optimizing their care and to enrich the debate on the use of POCs. METHOD: Semi-structured interviews were conducted with 11 patients between ages 20 and 32, who were either undergoing a POC or had done so in the previous 5 years, followed by a semi-pragmatic phenomenological analysis of the resulting transcripts. RESULTS: (1) The outpatient experience with restraints is contradictory, ranging from deprivation and intrusion to support and protection. (2) The POC is portrayed as a framework for developing awareness of disorders and acceptance of care. (3) Patients report a lack of information about care with restraints, even to the point of being unaware of its existence. Patient-psychiatrist interactions within the POC are complicated by the restraints, but remain perceived as a care relationship. (4) They report constraints in their daily lives in connection to the POC, which can complicate professional involvement. CONCLUSION: The results support the importance of nurturing the therapeutic relationship within the POC and involving patients more in their care, starting with better information. They support the use of POCs as a temporary tool to be combined with work on adherence to treatment and support for social and professional reintegration. SPECIALTY: Psychiatry.

OBJECTIF: Les dispositifs de soins ambulatoires sans consentement sont largement utilisés, mais ils sont controversés et leur efficacité n'est pas prouvée à ce jour. L'expérience des patients concernés reste très peu étudiée en France, et notamment celui des jeunes patients, or leur adhésion aux soins en début de maladie est complexe et a un impact sur le pronostic futur. L'objectif est d'étudier l'expérience de jeunes patients suivis en programme de soins (PDS) afin de proposer des perspectives pour optimiser leur prise en charge et d'enrichir la réflexion sur l'utilisation des PDS. MÉTHODE: Des entretiens semi-directifs ont été réalisés auprès de 11 patients de 20 à 32 ans suivis en PDS ou l'ayant été dans les 5 dernières années, puis une analyse phénoménologique de type sémio-pragmatique a été réalisée sur les verbatims obtenus. RÉSULTATS: (1) L'expérience de la contrainte en ambulatoire est contrastée avec un vécu de privation de libertés et d'intrusion, mais aussi de soutien et de protection. (2) Le PDS est représenté comme un cadre permettant l'évolution de la conscience des troubles et de l'acceptation des soins. (3) Les patients rapportent un manque d'information sur les modalités de soins sous contrainte, pouvant aller jusqu'à la méconnaissance de l'existence de cette mesure. Les interactions patient-psychiatre au sein du PDS sont complexifiées par la contrainte mais restent perçues comme une relation de soin. (4) Ils rapportent des contraintes dans la vie quotidienne liées au PDS et qui peuvent compliquer l'insertion professionnelle. CONCLUSION: Les résultats soutiennent l'importance de soigner la relation thérapeutique au sein du PDS et d'impliquer davantage le patient dans sa prise en charge, en commençant par une meilleure information. Ils soutiennent une utilisation du PDS comme un outil temporaire à associer à un travail sur l'adhésion aux soins et à un accompagnement à la réinsertion sociale et professionnelle. SPÉCIALITÉ: Psychiatrie.

[Addictions in the elderly: the viewpoint of an IPA working in EMPSA]. / Les addictions chez le sujet âgé : regard d'une IPA exerçant en EMPSA.

Many elderly people live well and at home, but some require somatic and psychiatric care. Mobile psychiatric teams for the elderly are called upon to intervene with people aged 65-70 and over who are experiencing psychological distress. Among senior citizens, addictive disorders are very common, and are associated with psychiatric and geriatric co-morbidities. Alcohol, tobacco and benzodiazepine use disorders require holistic, individualized care, based on identification, prevention and referral, as well as training and coordination of professionals and caregivers.

[From nursing to changing social representations: the study of health literacy in psychiatry]. / Des sciences infirmières à la modification des représentations sociales : l'étude littératie en santé en psychiatrie.

The Litterapsy study focuses on the assessment of health literacy in patients with psychiatric disorders, a field that has been little studied in France. It is based on the observations of an advanced practice nurse specializing in psychosocial rehabilitation. Its aim is to provide objective data to better understand how these patients understand medical information and navigate the healthcare system.

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.