Four Questions Nurses Can Ask to Predict PTSD 1 Year After a Motor Vehicle Crash.

BACKGROUND: The role of nurses in screening for posttraumatic stress disorder is crucial in trauma units. OBJECTIVES: To create and evaluate an easy and brief tool for nurses to predict chronic posttraumatic stress disorder 1 year after a motor vehicle crash. METHODS: We performed a 1-year follow-up multicenter study from 2007 to 2015, including 274 patients injured in a motor vehicle crash who were hospitalized in an orthopedic trauma unit. Nurses administered the DEPITAC questionnaire. Posttraumatic stress disorder was measured by the Post-Traumatic Stress Disorder Checklist of symptoms during the first year following the crash. A multivariable logistic regression model was implemented to select items significantly associated with posttraumatic stress disorder to improve the DEPITAC questionnaire. Predictive performance to predict posttraumatic stress disorder 1 year after the motor vehicle crash was examined for these different models. RESULTS: Of 274 patients studied, a total of 75.9% completed the questionnaire at 1 year of follow-up. We found that only two questions and two simple elements of the patient's medical record (other injury or a person dying during the crash, perception of vital threat, number of children, and length of stay in trauma) predicted posttraumatic stress disorder 1 year after a motor vehicle crash. CONCLUSIONS: The brevity of this evaluation, simple scoring rules, and screening test performance suggest that this new screening tool can be easily administered in the acute care setting by nurses.

Modulation of fronto-limbic activity by the psychoeducation in euthymic bipolar patients. A functional MRI study.

Bipolar disorders (BD) are mainly characterized by emotional and cognitive processing impairment. The cerebral substrate explaining BD impairment and the action mechanisms of therapies are not completely understood, especially for psychosocial interventions. This fMRI study aims at assessing cerebral correlates of euthymic bipolar patients (EBP) before and after psychoeducation therapy. Sixteen EBP and 16 matched healthy subjects (HS) performed a word-face emotional Stroop task in two separate fMRI sessions at 3-month interval. Between fMRI sessions, EBP underwent psychoeducation. Before psychoeducation, the comparison of EBP vs. HS in fMRI data revealed (a) significant decreased activity of cognitive control regions such as bilateral inferior and left superior frontal gyri, right insula, right fusiform gyrus and bilateral occipital gyri and (b) significant increased activity of emotion-related processing regions such as bilateral hippocampus, parahippocampal gyri and the left middle temporal gyrus. After psychoeducation, EBP showed significant clinical improvement, increased activity of inferior frontal gyri and a tendency toward decreased activity of right hippocampus and parahippocampal gyrus. These results suggest that the imbalance between cognitive control and emotion processing systems characterizing BD acute episodes may persist during euthymic periods. Moreover, this imbalance may be improved by psychoeducation, which enhances the cognitive control and modulates emotional fluctuations in EBP.

[Adolescence, substance abuse and suicide attempt by jumping from a window]. / Adolescence, prise de toxiques et tentative de suicide par défenestration.

Suicide represents, in France, the second cause of death in youth aged 15 to 24. Sixteen per cent of juvenile mortality is attributable to suicide. The annual incidence of suicide attempts in this age group is estimated at about 40 000 cases. Jumping from high represents 6% of deaths from suicide: girls resort to this method twice as often as boys. The severity of somatic consequences and the frequency of sequels following a jumping from a window can hold center stage for a long time, at the risk of trivializing the psychopathology underlying such a violent acting-out. These clinical situations particularly involve a multidisciplinary follow up including an early and active participation of psychiatric consultation-liaison teams. Jumping from a window can occur even apart from established mental disorders, such as psychotic or mood disorders. Our four case-reports draw attention to risk factors represented by: substance abuse (alcohol, cannabis, but also cocaine, ecstasy...), the notion of previous suicide attempts and various drive disorders having a self-harm value or displaying an underlying impulsiveness (eating disorders, scarifications, shoplifting, running away...), the precipitating role of a recent loss of a parent or an important removal from family environment, the potential influence, especially in this age group, of spectacular cases of suicide amplified by the Medias ("Werther effect"). Paradoxically, to belong to a well-off milieu can also contribute to the risk of such acting-out, when parents replace affection and availability by an easy access to various consumer goods and a permissive education, thus opening the way to the encounter with different substances.