[Access to digital pornography by children and teenagers: when should you be alerted?] / Accès à la pornographie numérique par les enfants et adolescent-es : quand s'alerter ?

Pornography and, more broadly, the consumption of sexually explicit images are not new phenomena. However, the rise of new technologies has significantly facilitated access to this type of content, especially among young people. In what family context does the use of digital tools occur? What are the stakes of exposure in children and adolescents? What impacts on psychosexual development? What are the reasons for the difficulty in restricting this behaviour? Is there an addictive dimension? Health professionals and trusted adults have a role to play, both in preventing exposure to unsolicited and potentially shocking content, and in opening up a dialogue in the case of problematic situations for the child or adolescent.

La pornographie et, de manière plus générale, la consommation d'images à caractère sexuel ne sont pas des phénomènes nouveaux. Cependant, l'essor des nouvelles technologies a considérablement facilité l'accès à ce type de contenu, notamment chez les jeunes. Dans quel contexte familial s'inscrit l'utilisation des outils numériques ? Quels sont les enjeux d'une exposition chez les enfants et les adolescent-es ? Quels sont les impacts sur le développement psychosexuel ? Quelles sont les raisons de la difficulté à restreindre ce comportement ? Existe-t-il une dimension addictive ? Les professionnel-les de la santé et les adultes de référence ont un rôle à jouer à la fois pour prévenir l'exposition à des contenus non sollicités et potentiellement choquants, et pour ouvrir le dialogue en cas de situation problématique pour l'enfant ou l'adolescent-e.

[AdoASSIP, a novel therapeutic tool for the prevention of youth suicide]. / AdoASSIP: un nouvel outil thérapeutique dans la prévention du suicide des jeunes.

Suicide is the leading cause of death among Swiss adolescents. Often, a suicide attempt is the outcome of a "suicidal process" at the end of which death is perceived as the only means of escaping from intolerable psychic pain. A suicide attempt entails a high risk of repetition. AdoASSIP, a brief adjunctive therapy adapted for adolescents, which is being implemented in Switzerland, specifically aims at reducing that risk. Starting from the story of the suicide attempt told by the adolescent, patient and therapist jointly try to better understand the "logic" of the suicidal process. Short-term and long-term needs, as well as warning-signs of a crisis are identified, and a safety plan is developed. AdoASSIP is now available in the cantons of Geneva and Vaud.

Le suicide est la première cause de mortalité chez les adolescents suisses. Une tentative de suicide est souvent l'issue d'un «processus suicidaire¼ au terme duquel la mort est perçue comme seul moyen d'échapper à une douleur psychique intolérable. Une tentative de suicide comporte un risque important de réitération. AdoASSIP, une thérapie brève adjonctive adaptée pour les adolescents, qui est en cours d'implantation en Suisse, vise spécifiquement à diminuer ce risque. À partir du récit de la tentative de suicide racontée par l'adolescent, patient et thérapeute essayent conjointement de mieux comprendre la «logique¼ du processus suicidaire. Les besoins clés à court et long termes, ainsi que les signaux d'alerte d'une crise, sont identifiés et un plan de sécurité est élaboré. AdoASSIP est désormais disponible dans les cantons de Genève et Vaud.

Individualized pretest risk estimates to guide treatment decisions in patients with clinical high risk for psychotic disorders.

INTRODUCTION: Clinical high risk for psychosis (CHR) states are associated with an increased risk of transition to psychosis. However, the predictive value of CHR screening interviews is dependent on pretest risk enrichment in referred patients. This poses a major obstacle to CHR outreach campaigns since they invariably lead to risk dilution through enhanced awareness. A potential compensatory strategy is to use estimates of individual pretest risk as a 'gatekeeper' for specialized assessment. We aimed to test a risk stratification model previously developed in London, UK (OASIS) and to train a new predictive model for the Swiss population. METHOD: The sample was composed of 513 individuals referred for CHR assessment from six Swiss early psychosis detection services. Sociodemographic variables available at referral were used as predictors whereas the outcome variable was transition to psychosis. RESULTS: Replication of the risk stratification model developed in OASIS resulted in poor performance (Harrel's c=0.51). Retraining resulted in moderate discrimination (Harrel's c=0.67) which significantly differentiated between different risk groups. The lowest risk group had a cumulative transition incidence of 6.4% (CI: 0-23.1%) over two years. CONCLUSION: Failure to replicate the OASIS risk stratification model might reflect differences in the public health care systems and referral structures between Switzerland and London. Retraining resulted in a model with adequate discrimination performance. The developed model in combination with CHR assessment result, might be useful for identifying individuals with high pretest risk, who might benefit most from specialized intervention.

[Suicide attempt: encounter, evaluation, orientation]. / Tentative de suicide des adolescents: accueil, evaluation, orientation.

Suicide and suicide attempts of adolescents are major public health issues. Based on a model of care developed in Geneva, we describe the conditions necessary to evaluate and guide a teenager trapped in a suicidal behavior. First of all, there must be some time dedicated to pediatric assessement followed by a psychiatric evaluation and finally, the adolescent can be oriented toward specific treatment. Depending on the clinical characteristics of the young adolescent and according to his willingness to engage himself in intensive follow-up (impulsivity, anxious?--depressive symptomatology...), cares will be given either as outpatient with close monitoring or inpatient.

Improving Pathways to Care for Patients at High Psychosis Risk in Switzerland: PsyYoung Study Protocol.

AIMS: Psychotic disorders are one of the main causes of chronic disability in young people. An at-risk mental state (ARMS) is represented by subclinical symptoms that precede the first episode of psychosis (FEP). The PsyYoung project aims to optimize the detection of an ARMS while reducing unnecessary psychiatric treatments. It investigates the effects of service changes on the referrals and outcomes of young people with ARMS or a FEP. METHODS: Six psychiatric outpatient clinics in three cantons (Basel-Stadt, Vaud, and Geneva) participated in the project. They passed through an implementation phase including service changes and the adaptation of a standardized stepped care model for diagnosis and assessment, in addition to measures for increasing the awareness, networking and training of local professionals. PRELIMINARY RESULTS: All participating cantons had entered the implementation phase. By March 2023, there were 619 referrals to participating sites. A total of 163 patients (37% FEP and 31% ARMS) and 15 close relatives had participated in individual longitudinal assessments, and 26 patients participated in qualitative interviews. CONCLUSION: This national collaborative project addresses the issue of early intervention for emerging psychoses, and creates spaces for fruitful reflections and collaboration in Switzerland. The ultimate aim of PsyYoung is to harmonize clinical practices in early intervention of psychosis on a national level.

Mapping Child and Adolescent Mental Health Services and the Interface During Transition to Adult Services in Six Swiss Cantons.

Rationale: Transition in psychiatry refers to the period where young people transit from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS). Discontinuity of care during this period is well-documented but little is known about provisions and transition characteristics and policies across Switzerland. The aim of this article is to describe the architecture of public mental health providers in Switzerland and compare it to EU countries. Method: Two mapping surveys, developed previously for European countries, were adapted and sent to cantonal experts: the adapted European CAMHS Mapping Questionnaire (ECM-Q) assessing the architecture and functioning of CAMHS and the adapted Standardized Assessment Tool for Mental Health Transition (SATMeHT) to map CAMHS-AMHS interface. Results: Data were gathered from six cantons. Activity data and transition policies were comparable between Swiss regions and European countries. The percentage of young people below 19 years who were in care was above 2% in every responding canton with a higher proportion of boys than girls for patients <12 years of age. The transition occurred at the age of 18 years, civil majority, in each canton, and between 0 and 24% (3/7) and 25% and 49% (4/7) of young people were expected to transition. One canton (1/7) benefitted from written guidelines, at the CAMHS level only, regarding transition but none had guidelines for mapping CAMHS/AMHS interface even at the regional level. Conclusion: Despite the availability of resources and even if the possibilities of access to care are on average higher than in many European countries, issues regarding transition remain comparable in six Swiss cantons when compared to Europe. Meaning that beyond resources, it is the coordination between services that needs to be worked on. Importantly, implementing those changes would not require investing financial resources but rather working on the coordination between existing teams.

The implementation and first insights of the French-speaking Swiss programme for monitoring self-harm.

AIMS OF THE STUDY: Self-harm is a major risk factor for suicide but remains poorly documented. No data on self-harm in French-speaking Switzerland exist. To address this deficiency, the Swiss Federal Office of Public Health commissioned a specific self-harm monitoring programme. We present and discuss its implementation and first findings. METHODS: Every patient aged 18–65 years presenting for self-harm to the emergency departments of the Lausanne and Neuchâtel general hospitals were included in the monitoring programme over a 10-month period (December 2016 to September 2017). Clinicians collected anonymous sociodemographic and clinical data. RESULTS: The sample included 490 patients (54.9% female and 45.1% male) for 554 episodes of self-harm, showing a higher proportion of patients aged 18–34 (49.2%) than older age groups (35–49, 33.7% and 50–65, 17.1%). Patients were mostly single (56.1%) and in problematic socioeconomic situations (65.7%). Self-poisoning was the most commonly used method (58.2%) and was preferred by women (71% of females and 42.5% of males, Fisher’s exact test, p <0.001) and the majority of patients (53.3%) had experienced at least one previous episode of self-harm. The self-harm rate was 220 per 100,000 inhabitants in Lausanne and 140 in Neuchâtel. Suicidal intent was clear for 50.6% of the overall sample, unclear for 25.1% and absent for 24.3%. It differed significantly between sites (χ2(2) = 9.068, p = 0.011) as Lausanne reported more incidents of unclear intent (27.7% versus 17.4% in Neuchâtel) and Neuchâtel more incidents with absence of intent (33.1% versus 21.3% in Lausanne). In Lausanne, patients more frequently resorted to methods such as jumping from a height (11.4%) and hanging (9%) than in Neuchâtel (1.6% and 4.9%, Fisher’s exact test, p = 0.006). CONCLUSIONS: Our results are globally consistent with previous research on self-harm. We found significant inter-site differences in methods, suicidal intent and self-harm rates. Our findings highlight the importance of implementing local self-harm monitoring to identify specific at-risk groups and develop targeted preventive intervention.