Corrigendum: Paradoxes in borderline emotional dysregulation in adolescence: influence of parenting, stressful life events, and attachment.

[This corrects the article DOI: 10.3389/fpsyt.2021.735615.].

Medical Students' Learning Process During Simulated Patient Consultations in Psychiatry: A Grounded Theory Study.

INTRODUCTION: Recent changes in psychiatric care and teaching, which limit patient contact for medical students, can be partially overcome by simulation-based education in psychiatry. The authors explored the learning processes of medical students during meetings with simulated patients to inform efforts to improve this teaching. METHODS: After recruiting 81 undergraduate medical students from 3 universities to participate in 6 simulation sessions in psychiatry, the authors purposively sampled 21 students to participate in face-to-face individual semistructured interviews analyzed with constructivist grounded theory. Integration of this analysis with those of the simulation consultation videotapes and the debriefing audiotapes improved the triangulation process. RESULTS: Three organizational themes were identified: developing and structuring representations of psychiatry; integrating subjectivity into learning; and refining and developing psychiatric praxis. Given the broad and in-depth learning that occurs, simulation in psychiatry should respect content validity of SP portrayals to ensure appropriate learning. However, psychological fidelity seems to provide adequate realism while retaining feasibility. Psychiatric simulation also requires the encouragement of student self-confidence and well-being. Within a reflective framework, simulation triggers cognitive reframing, which can alleviate fears and prejudice toward people with mental disorders. CONCLUSIONS: The holistic interactive learning process involved in simulation can address the complexity of the personal and interpersonal features needed in psychiatry.

The impact of a telephone hotline on suicide attempts and self-injurious behaviors in patients with borderline personality disorder.

Background: Borderline personality disorder is often associated with self-injurious behaviors that cause personal suffering, family distress, and substantial medical costs. Mental health hotlines exist in many countries and have been shown to be effective in some contexts, but none have been specifically designed for borderline patients. The aim of the present study is to evaluate the impact of a 24/7 hotline dedicated to patients with borderline personality disorder on suicide attempts and self-injurious behaviors. Methods: We conducted a single-blind, multicenter (9 French centers) clinical trial with stratified randomization (by age, sex and center). Patients (N = 315) with a diagnosis of borderline personality disorder (according to the SIDP-IV) were randomized into two groups with or without access to the hotline in addition to treatment as usual. The number of suicide attempts and self-injurious behaviors in each group within 12 month were analyzed in the "per protocol" population (Student's t-tests, 5% significance threshold), adjusting for possible confounders in a multivariate analysis (using Poisson regression). The percentage of patients with suicide attempts and with self-injurious behaviors (and other percentages) were analyzed in the per protocol population (χ2-tests or exact Fischer tests, 5% significance threshold). Results: The mean number of suicide attempts was 3 times lower in the hotline group (0.41 vs. 1.18, p = 0.005) and the mean number of self-injurious behaviors was 9 times lower (0.90 vs. 9.5, p = 0.006). Multivariate analysis confirmed the effectiveness of the hotline in reducing suicide attempts and self-harm. Conclusion: This study supports the effectiveness of hotlines in reducing self-aggressive behavior in patients with borderline personality disorder. Such support is easy to use, cheap and flexible, and therefore easy to implement on a large scale.

Characteristics of older patients in the largest French psychiatric emergency centre.

Despite an increasing number of adults older than 60 years with psychiatric disorders, there are few studies on older patients in psychiatric emergencies and no European data. We aimed to describe the population of patients aged 60 years and older who presented to the main French psychiatric emergency centre and identify predictors of psychiatric hospitalization. This monocentric study included 300 consecutive patients aged 60 years and older. Patients presenting because of psychiatric emergencies were frequently female and lived autonomously. More than 40% had a history of at least one psychiatric hospitalization and 44% had consulted a psychiatrist in the previous 6 months. The most common reasons for consultation were depression, anxiety, sleep disorders and suicidal thoughts. Psychiatric disorders were mainly mood disorders; neurotic, stress-related and somatoform disorders; and schizophrenic, schizotypal and delusional disorders. Only 10% had a diagnosis of organic mental disorders. Overall, 39% of the patients were admitted to the psychiatric hospital. Factors predicting hospitalization were a history of psychiatric hospitalization, suicidal thoughts and a diagnosis of a mood disorder or schizophrenia/schizotypal/delusional disorder. In conclusion, among people aged 60 years and older who consulted for psychiatric emergencies, 39% had to be hospitalized in psychiatry and only psychiatric factors influenced the decision to hospitalize. Our study highlights the need for further studies of older people in psychiatric emergencies in Europe, to anticipate the needs of this specific population and adapt multidisciplinary mental health care.

Formation des infirmiers à l'évaluation du risque suicidaire : revue de la littérature et perspectives pour la pratique avancée infirmière.

Context : Nurses are regularly confronted with suicidal people. Their involvement is essential in the detection and prevention of suicide risk.Objectives : Through a literature review, we wanted to highlight the role of the advanced practice nurse by conducting specific training to improve nursing skills in the management of people with suicidal thoughts.Method : Our literature review was carried out according to the PRISMA recommendation criteria from several databases.Results : The review showed an improvement in confidence, attitudes, and nursing skills in assessing suicide risk. However, no long-term change in practice was demonstrated.Discussion : In France, a national training program on suicide risk prevention is implemented at the regional level by the Regional Health Agencies. At the same time, since 2019, Psychiatry and Mental Health has been part of the training program for advanced practice nurses.Conclusion : The advanced practice nurse is a central player in supporting teams in increasing their skills, particularly when conducting specific training.

Adversity, attachment and emotion recognition in BPD adolescents: the distinct roles of disengaged and controlling environment.

BACKGROUND: Literature data about emotion perception in patients with borderline personality disorders (BPD) revealed some discrepancies between some patients that are vigilant and accurate to detect their emotional environment and others that are impaired at identifying emotions of others. Even if some links between childhood adversity and facial affect recognition have been established, there is a need to understand the heterogeneous psychobiological mechanisms underlying this association. The aim is to distinguish in a BPD sample, the links between facial emotion recognition (FER) and adversity types (maltreatment and parental bonding), by evaluating two dimensions of disengaged and controlling environment. METHOD: The study includes BPD adolescents (n = 45) and healthy controls (HC, n = 44): two scores of disengaged environment (parental low care; emotional and physical neglect) and controlling environment (high level of parenting control; emotional, physical and sexual abuse) were established and correlated to FER, as well as to attachment dimensions. Multiple linear regression analyzes were conducted to evaluate the effect of disengaged and controlling dimensions, on FER scores of sensitivity and accuracy, including anxious and avoidant attachment as covariables. RESULTS: Analyzes revealed that a disengaged environment was positively correlated to sensitivity in BPD patients, and the correlation was negative in the HC group. Controlling environment was negatively associated to accuracy of emotion in BPD. Avoidant and anxious attachment did not influence these associations. CONCLUSIONS: These results suggest that distinct adverse experiences account for the heterogeneity observed in emotion regulation in BPD patients.

Pupil psychosensory reflex in response to own and standardised silhouettes in patients with anorexia nervosa.

OBJECTIVE: This study aimed to assess the physiological response of patients with anorexia nervosa (AN) to different types of silhouettes using pupillometry. METHODS: We measured the pupil psychosensory reflex (PSR) of 42 patients with AN and 35 healthy controls in response to standardised body silhouettes and to pictures of their own silhouettes digitally modified to represent different body mass indices (BMI). Perceptual distortion and body dissatisfaction were assessed using Anamorphic Micro Software©. Twenty-three of the recruited patients were tested up to four times during an inpatient treatment programme to assess the impact of weight gain. RESULTS: PSR correlated with the subjective rating of emotional arousal in controls but not in patients. Own silhouettes and standardised silhouettes triggered a different pupil response both in patients with AN and in controls. With pictures of their own silhouettes, pupil response to underweight stimuli differed from pupil response to normal weight or overweight stimuli in both groups. Weight gain was associated with an increase in PSR, an improvement of ideal BMI and a decrease of body dissatisfaction, but no change in perceptual distortion. CONCLUSION: Our findings support the idea that pupillometry could be a useful tool to assess the physiological state of patients with AN.

Interpersonal Relatedness and Non-suicidal Self-Injurious Behaviors in Female Adolescents With Borderline Personality Disorder.

Background: Psychopathological models of adolescent borderline personality disorder (BPD) suggest that non-suicidal self-injuring (NSSI)-a particularly frequent symptom in girls-may constitute a way of coping with distress resulting from interpersonal concerns they typically experience as a developmental psychopathological feature. Objectives: Our objective was to investigate the relationship in BPD female adolescents between NSSI and the Sidney Blatt two-polarities model of personality development, which focuses on the psychological processes of interpersonal relatedness and self-definition. Methods: The study was conducted within the European Research Network on Borderline Personality Disorder in Adolescence, using the Depressive Experience Questionnaire (DEQ). Results: BPD patients (n = 59; mean age = 16.6 ± 1.3) scored significantly higher than healthy controls on the two DEQ sub-factors assessing the more immature forms of Interpersonal Relatedness (Neediness) and Self-definition (Self-criticism) and significantly lower on the more mature form of Self-definition (Efficacy). BPD adolescents with NSSI showed significantly higher scores on both mature and immature forms of Interpersonal Relatedness (Neediness and Connectedness) compared to BPD adolescents without NSSI. A logistic regression analysis showed that the subfactor Neediness of the DEQ was the only significant predictor of the presence of NSSI among BPD adolescents. Conclusions: The preliminary results of this study suggests that NSSI in adolescents with BPD is developmentally linked to high developmental concerns in the domain of interpersonal relatedness, which may be taken into consideration in clinical practice. More studies are necessary to better understand the relationships between NSSI and developmental psychopathology in borderline adolescents.

Paradoxes in Borderline Emotional Dysregulation in Adolescence: Influence of Parenting, Stressful Life Events, and Attachment.

Introduction: Borderline personality disorder (BPD) in adolescents is characterized by emotional dysregulation, insecure attachment, a history of stressful life events (SLEs) as well as dysfunctional parent-child interactions. The respective contribution of each of these factors on BPD affective symptoms is not yet clear. The purpose of this study is to assess the distinct impact of parental adversity and SLEs on BPD affective symptoms and the role of attachment and alexithymia in such emotional processes. Method: This study explored parental dysfunction and SLEs as predictors of affective symptoms of BPD and of attachment insecurity in BPD adolescents (n = 85) and healthy controls (n = 84) aged 13-19 years from the European Research Network on BPD. The links between adversity and BPD symptoms were also investigated by emotional dysregulation assessment, as measured by alexithymia and hopelessness. Results: Dysfunctional parental interactions were linked to affective symptoms, hopelessness, and anxious attachment in healthy controls but not in BPD. Cumulative SLEs were positively correlated with affective symptoms and avoidant attachment in the control group but negatively correlated with both these variables in BPD. Multivariate regression analysis revealed that, in BPD, affective symptoms were independent of dysfunctional parenting but depended on attachment, whereas in controls, a maternal affectionless control style directly predicted affective symptoms. Moreover, increasing numbers of SLEs reduced affective symptoms in BPD, independently of parental interactions or attachment, and were associated with growing use of operative thinking. Discussion: BPD patients showed paradoxical emotional reactions: there was no increase of hopelessness and affective symptoms with an increased parental dysfunction, but a decrease in affective symptoms and hopelessness with cumulative SLE. Two pathways arose, one involving attachment as an emotional dysregulation process for parent-child interactions and a second one for SLE, with a more direct pathway to affective symptoms, independent of attachment but dependent on early interactions, and involving alexithymia. In summary, adversity factors have distinct effects in BPD, and attachment is partly accountable for affective symptoms independently of adversity. Our results suggest that in highly insecure conditions, cumulative adversity may produce paradoxical effects, including a lesser expression of affective symptoms and hopelessness.

The ACAMTO study-impact of add-on osteopathic treatment on adolescent patients with anorexia nervosa: study protocol for a randomized controlled trial.

BACKGROUND: Anorexia nervosa (AN) mainly affects women (sex ratio 1/10) and most often starts during adolescence. The prognosis of AN remains poor (10% of deaths and high risk of chronicity). Body dissatisfaction, disturbances in recognition and identification of body sensations are some of the key symptoms of AN. However, there is a contrast between this consensual observation of body image disorders in AN, and the relative deficit of specifically targeted body treatments. Our proposal for a body approach specifically dedicated to AN is based on the understanding that posture, breathing, muscle tension and body perception are closely linked to our psychological and emotional state and are therefore disturbed in patients with AN. The purpose of this monocentric randomized controlled trial is to evaluate if a targeted osteopathic protocol treatment for AN in addition to treatment as usual (TAU) is significantly more effective than TAU alone. METHODS: In total, 72 patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups: one receiving the specific osteopathic treatment targeted for AN in addition to the TAU (group A) and the other one, receiving TAU only (group B). The patients in group A will receive 5 30-min osteopathic treatment sessions. Soft specific palpatory techniques on the diaphragm, digestive system and cervical region will be performed. The TAU is defined by the multidisciplinary approach recommended by the French health high authority. The primary outcome is the evaluation of interoceptive sensibility and secondary outcomes include clinical and psychopathology-related symptoms with assessment of somatic dysfunctions' evolution. A qualitative study will also be carried out, applying the Interpretative Phenomenological Analysis method. Patients will be included for a maximum of 14 weeks between the inclusion time and the last evaluation. DISCUSSION: If the results of the study are positive (statistically significant efficacy of this osteopathic treatment protocol), the study will provide arguments in favor of osteopathic sessions as a possible non-invasive additional treatment option in the multidisciplinary care approach for patients with AN. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04666415 , Release Date: December 11, 2020; N° ID-RCB: 2019-A02613-54.

Borderline personality disorder and adolescent suicide attempt: the mediating role of emotional dysregulation.

BACKGROUND: Emotional dysregulation seems to be a core feature of Borderline Personality Disorders (BPD). In addition, recent research in the adolescent population has shown that suicidal behaviours have been associated with maladaptive strategies of emotion regulation. METHODS: This study examined the relative contributions of emotional dysregulation to suicide attempt history in a clinical sample of borderline adolescents. Data were analyzed from 85 participants of the Collaborative European Research Network on Borderline Personality Disorder. Participants completed measures of BPD traits and symptoms, suicide behaviours, emotional dysregulation, attachment styles and lifetime depressive disorders. RESULTS: In an SEM model, lifetime depressive disorders and insecure attachment styles have a significant direct effect on lifetime suicide attempt, but only lifetime depressive disorders have an indirect effect through emotion dysregulation. The results suggest that emotional dysregulation has a mediating role in suicide attempts among BPD adolescents. CONCLUSIONS: These findings call for the development of interventions targeting the role of emotion dysregulation in effectively predicting and preventing suicidality in borderline adolescents.

Eating disorders and sexuality: A quantitative study in a French medically assisted procreation course.

OBJECTIVE: Among medically assisted procreation (MAP) patients, the prevalence of eating disorders (ED), clinical or subclinical, current or past, is considerable. In addition to metabolic repercussions, the literature suggests that these patients present with more sexual dysfunction, leading to anxiety. This quantitative research on a population of women consulting a MAP department for unexplained or ovulatory infertility proposed to study the sexuality of this population by comparing the sexuality of patients suffering from or having suffered from an ED to the sexuality of the non-ED group. METHOD: Patients (n = 61) filled out the Eating Disorder Examination Questionnaire (EDE-Q), the Brief Index of Sexual Functioning for Women (BISF-W), the ED Whole Life Research Questionnaire, the Hospital Anxiety and Depression Scale (HADS) and the Kansas Marital Satisfaction Scale (KMSS). RESULTS: We found a prevalence of 54% of ED, current or past. Even though these patients reported the same prevalence of sexual intercourse, they had significantly more physical problems (e.g., anorgasmia, vaginismus, headache) affecting their sexuality (p = .01) than the non-ED group, after adjusting for depression. Approximately 10% of the study population reported no intravaginal intercourse during the last month. DISCUSSION: This study provides evidence for the existence of more sexual dysfunction in patients who have a fertility disorder and have ED or a history of ED. Future research should evaluate the results of psychological or sexological care that may be more suitable for the infertility of these patients.

Specific Pathways From Adverse Experiences to BPD in Adolescence: A Criteria-Based Approach of Trauma.

Within the European Research Network on BPD (EURNET-BPD; n = 85 BPD adolescents, n = 84 healthy controls, aged 13-19), this study explored the combination of three types of adversity-maltreatment, stressful life events (early separation from parents, parental suicide attempt, parental chronic disease) and parental bonding-as predictors of BPD, on a criteria-based approach. Results indicated that cumulative traumatic experiences largely characterize borderline adolescent's history; and, in the multivariate regression models, all adversity experiences were likely to contribute to BPD symptoms. The role of emotional abuse, parental suicide attempt, and a decrease in paternal level of care were particularly prominent. Moreover, adversities combinations were different for each criterion, suggesting that specific sets of traumatic experiences are leading to BPD. These findings argue for a further criteria-based exploration of trauma in borderline patients, as well as a more accurate and efficient prevention.

Prevalence of lifetime eating disorders in infertile women seeking pregnancy with pulsatile gonadotropin-releasing hormone therapy.

OBJECTIVES: Relationships between weight and fertility are well known. The aim of this study is to assess the prevalence of lifetime eating disorder (ED) in a sample of infertile women seeking a specific infertility treatment, pulsatile gonadotropin-releasing hormone (pGnRH) treatment, and to compare it to the prevalence of lifetime ED in a sample of infertile women seeking other types of assisted reproductive technology (ART) treatments. DESIGN: Non-randomized, observational study including infertile female patients. Two-group design including consecutive women treated with GnRH pump (pGnRH) or with other types of ART. SETTING: Multi-centric infertility centers, France METHODS: Twenty one consecutive women treated with pGnRH treatment were compared to 21 consecutive women receiving other types of infertility treatment. Diagnosis of ED was based on DSM-IV and the Composite International Diagnostic Interview (CIDI). RESULTS: Twenty patients (95.2%) from the sample of women treated with pulsatile GnRH treatment and 5 patients (23.8%) from the patients receiving other types of infertility treatment met the criteria of lifetime ED diagnosis (p < 0.000). CONCLUSION: This study highlights the fact that the prevalence of ED is considerably higher in women receiving GnRH pulsatile treatment, when compared to women receiving other kinds of infertility treatment. In our study population ED were under-diagnosed, particularly in women receiving pulsatile GnRH treatment. Fertility clinicians should use reliable diagnostic tools to identify promptly ED in women presenting with hypothalamic amenorrhea and difficulties in conceiving. Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Patient flow in the largest French psychiatric emergency centre in the context of the COVID-19 pandemic.

To date, we have no French data about the psychiatric consequences of the Covid-19 pandemic and the confinement. In the largest French psychiatric emergency centre, we compared the average number of consultations per day during the confinement with the same period preceding the confinement and with the same periods of previous years, and we observed a significant drop in attendance. Our team had to adapt promptly to these changes in public mental health services, and we set up a telephone hotline dedicated to psychiatric patients and their families, in order to prevent a secondary psychiatric crisis.

Validation of the French version of the McLean screening instrument for borderline personality disorder (MSI-BPD) in an adolescent sample.

BACKGROUND: The study examines the psychometric properties of the French version of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) created by M. Zanarini to screen borderline personality disorder in clinical and non-clinical populations. METHOD: In this multicentric longitudinal study from the European Network on Borderline Personality Disorder, a sample of 84 adolescent patients from five psychiatric centres and 85 matched controls without psychiatric comorbidity completed the MSI-BPD, French version, and were interviewed with the Structured Interview for DSM-IV Personality (SIDP-IV), in order to assess the presence or absence of borderline personality disorder. RESULTS: The MSI-BPD showed excellent internal consistency (α = 0.87 [0.84;0.90]). Compared to the semi-structured reference interview (SIDP-IV), the MSI-BPD showed substantial congruent validity (AUC = 0.93, CI 95%: 0.90-0.97). The optimal cut-off point in the present study was 5 or more, as it had relatively high sensitivity (0.87) and specificity (0.85). In our sample, the cut-off point (7 or more) proposed by the original developers of the MSI-BPD showed high specificity (0.95) but low sensitivity (0.63). CONCLUSIONS: The French version of the MSI-BPD is now available, and its psychometric properties are satisfactory. The French version of the MSI-PBD can be used as a screening tool for borderline personality disorder, for clinical purposes or in research studies.

Emotional intelligence, empathy and alexithymia in anorexia nervosa during adolescence.

PURPOSE: Socio-emotional difficulties have been observed on adult patients suffering from anorexia nervosa (AN). But researches with adolescents are scarce and non-congruent. The aim of this paper is to identify the socio-emotional difficulties that are encountered by AN during adolescence, and to isolate them from those encountered by control adolescents. METHOD: 41 AN and 38 control adolescents were assessed using the emotional quotient inventory by Bar-On, youth version (EQ-i: YV), the Toronto Alexithymia Questionnaire (TAS-20), the Interpersonal Reactivity Index (IRI), and anxiety and depression were controlled using the Hospital Anxiety and Depression Scale (HADS). RESULTS: Personal distress remains the main difference between the two groups, even when depression and anxiety are controlled. Intrapersonal difficulties are observed in the AN group, as well as alexithymic traits. CONCLUSION: Research on AN has to focus on the socio-emotional difficulties during adolescence, to properly identify which difficulties are linked to that life period, and which are a trait of AN. LEVEL III: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

[Care of unaccompanied minors in a psychiatric emergency unit]. / Prise en charge des mineurs non accompagnés en service d'urgences psychiatriques.

Emergency psychiatric units are receiving more and more foreign unaccompanied minors: for many of these young people it is their first contact with psychiatric services. This context of crisis crystallises the administrative and legal paradoxes at work in the support of these youngsters. Coordination between emergency care, statutory bodies and community-based care enables stability to be established while the care project is being set up.