[Transidentites : the relevance of involving psychiatrists]. / Transidentités : pertinence de l'implication des psychiatres.

Psychiatrists play a crucial role in evaluating requests and treatment indications for individuals experiencing gender incongruence, while also providing support throughout the transition process. Their work involves addressing both the psychological and somatic aspects of this journey, facilitating the profound identity changes it entails.

Les psychiatres psychothérapeutes jouent un rôle essentiel pour évaluer les demandes et les indications au traitement des personnes souffrant d'incongruence de genre, et les accompagner dans leur parcours de transition. Leur travail permet d'intégrer les enjeux psychologiques et somatiques de ce cheminement et de soutenir les remaniements identitaires profonds qu'il implique.

The Impact of the COVID-19 Pandemic on Unassisted Suicide and Assisted Suicide Rates in French-Speaking Switzerland: Differences by Gender.

Aims: Most studies on the impact of COVID-19 have shown a decrease or no change in unassisted suicide rates, but effects on assisted suicide have not been studied. We aimed to estimate the association between the COVID-19 pandemic and both types of suicide. Methods: Between 2017 and 2021, 1280 assisted suicides and 535 unassisted suicides were recorded in three Swiss cantons. We conducted descriptive and time series analyses on monthly suicide rates, categorized by gender. Results: Among women, a decrease in assisted suicide rates was found during the acute phases of the pandemic. Among men, assisted suicide rates increased gradually from the onset of the pandemic. Regarding unassisted suicide rates, no significant change was observed in women, while in men, there was a decrease, which was larger at the end than at the onset. Conclusions: COVID-19 had contrasting effects on assisted and unassisted men and women suicide rates.

Oncology clinicians' feelings towards patients presented in supervision: A pre-post assessment using the feeling word checklist.

OBJECTIVE: Clinical supervision of oncology clinicians by psycho-oncologists is an important means of psychosocial competence transfer and support. Research on this essential liaison activity remains scarce. The aim of this study was to assess the impact of supervision on oncology clinicians' feelings towards patients presented in supervision. METHODS: Oncology clinicians' (n = 23) feelings towards patients presented in supervision were assessed with the Feeling Word Checklist (FWC). The FWC was filled in by supervisees prior and after their supervision sessions (n = 91), which were conducted by experienced supervisors (n = 6). Pre- post-modification of feelings was evaluated based on a selection of FWC items, which were beforehand considered as likely to change in a beneficial supervision. Items were evaluated on session level using t-tests for dependent groups. Composite scores were calculated for feelings expected to raise and feelings expected to decrease and analysed on the level of supervisees. RESULTS: Feelings related to threats, loss of orientation or hostility such as "anxious", "overwhelmed", "impotent", "confused", "angry", "depreciated" and "guilty" decreased significantly after supervision, while feelings related to the resume of the relationship ("attentive", "happy"), a better understanding of the patient ("empathic"), a regain of control ("confident") and being "useful" significantly increased. Feeling "interested" and "calm" remained unchanged. Significant increase or decrease in the composite scores for supervisees confirmed these results. CONCLUSIONS: This study demonstrates modification of feelings towards patients presented in supervision. This modification corresponds to the normative, formative, and especially restorative function (support of the clinician) of supervision.

Severe post-pyloric injury after button battery ingestion: Systematic literature review and case report.

BACKGROUND: The health and safety hazards related to button batteries (BB) have been extensively studied, highlighting that the presence of a button battery in the esophagus is a life-threatening emergency. However, complications related to bowel BB are poorly evaluated and not well known. The objective of this review of the literature was to describe severe cases of BB that have passed the pylorus. CASE REPORT: This case, from the PilBouTox cohort, is the first report of small-bowel occlusion following ingestion of an LR44 BB (diameter: 11.4 mm) by a 7-month-old infant with a history of intestinal resections. In this case, the BB was ingested without a witness. The initial presentation mimicked acute gastroenteritis evolving into hypovolemic shock. An X-ray revealed a foreign body stuck in the small bowel causing an intestinal occlusion and local necrosis without perforation. The patient's history of intestinal stenosis and intestinal surgery were the contributing factor of impaction. SYSTEMATIC LITERATURE REVIEW: The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The research was conducted on September 12, 2022 through five database and the U.S. Poison Control Center website. An additional 12 severe cases of intestinal or colonic injury after ingestion of a single BB were identified. Of these, 11 were related to small BBs (< 15 mm) that impacted Meckel's diverticulum and one was related to postoperative stenosis. CONCLUSION: In view of the findings, the indications for digestive endoscopy for extraction of a BB in the stomach should include a history of intestinal stenosis or intestinal surgery so as to avoid delayed intestinal perforation or occlusion and prolonged hospitalization.

[Assisted suicide: a need for clarification]. / Suicide assisté : un besoin de clarification.

In Switzerland, altruistic assisted suicide is permitted. We present here the federal regulations, the deontological rules, the provisions adopted by the cantons and other requirements applicable to assisted suicide. Given the complexity of these different rules and the legal questions that remain open, we recommend the preparation of brochures for patients, as well as better training and support for people faced with requests for assisted suicide.

En Suisse, l'assistance altruiste au suicide est admise. Nous présentons ici la règlementation fédérale, les règles déontologiques, les dispositions adoptées par les cantons et les éventuelles autres exigences applicables en matière de suicide assisté. Vu la complexité de ces différentes règles et les questions juridiques encore ouvertes, nous recommandons la rédaction de brochures à destination des patients, ainsi qu'une meilleure formation et encadrement des personnes confrontées à des demandes d'assistance au suicide.

Two clinicians for one patient, is it worth it? Patients' perspective on receiving treatment from a pair of clinicians, in a psychiatric emergency and crisis unit.

BACKGROUND: In the field of psychiatric crisis interventions, treatment is commonly provided by multidisciplinary teams in Western countries. However, empirical data on the processes involved in this type of intervention are lacking, in particular from a patient perspective. Our study aims to gain a better understanding of the patients' experience of a treatment setting provided by a pair of clinicians in a psychiatric emergency and crisis intervention unit. Patients' perspective could provide a broader understanding of its advantages (or disadvantages), as well as bring new insight on elements influencing patients' treatment adherence. METHODS: We conducted 12 interviews with former patients treated by a pair of clinicians. The participants' experience, explored with semi-structured questions on their views of the treatment setting, was analyzed by means of thematic analysis using an inductive approach. RESULTS: The majority of participants experienced this setting as advantageous. A broader comprehension of their issues is the benefit most often expressed. A minority experienced seeing two clinicians as disadvantageous (having to talk to several clinicians at a time, change interlocutors, repeat one's story). Participants attributed joint sessions (with both clinicians) mainly to clinical reasons and separate sessions (with one clinician at a time) mainly to logistical ones. CONCLUSIONS: This qualitative study provides first insights into patients' experience of a setting including two clinicians providing emergency and crisis psychiatric care. The results show a perceived clinical gain of such a treatment setting for highly in crisis patients. However, further research is needed to evaluate the benefit of this setting, including the indication for joint or separate sessions as the patient's clinical course evolves.

[Health services and systems research in psychiatry - The systemic challenge of the ambulatory shift in psychiatry]. / Recherche sur les services et systèmes de santé en psychiatrie - Le défi systémique du virage ambulatoire en psychiatrie.

Health services and systems research examines the match between individual and population health needs and clinical services. In the context of the ambulatory shift in psychiatry, services research is important to ensure the quality of clinical developments, their appropriateness to patient and societal needs, their accessibility, efficiency, implementation and real-world outcomes. The purpose of this article is to present the principles that guide mental health services and systems research and to illustrate them with three examples related to the ambulatory shift in psychiatry. Research on services must be based on both epidemiological and clinical research as well as on partnerships with expert patients.

La recherche sur les services et systèmes de santé examine l'adéquation entre les besoins de santé des individus et de la population et les services cliniques. Dans le contexte du virage ambulatoire en psychiatrie, la recherche sur les services est importante pour assurer la qualité des développements cliniques, leur adéquation aux besoins des patients et de la société, leur accessibilité, leur efficacité, leur mise en œuvre et leurs résultats dans le monde réel. L'objectif de cet article est de présenter les principes qui guident la recherche sur les services et les systèmes de santé mentale et de les illustrer par trois exemples liés au virage ambulatoire en psychiatrie. La recherche sur les services doit se fonder sur la recherche épidémiologique et clinique ainsi que sur des partenariats avec des patients experts.

When to discharge and when to voluntary or compulsory hospitalize? Factors associated with treatment decision after self-harm.

Clinicians assessing suicidal patients in emergency departments (EDs) must decide whether to admit the person to a psychiatric ward with voluntary or compulsory hospitalization or to discharge him/her as an outpatient. This cross-sectional study aimed to identify independent predictors of this decision among a large sample of self-harm (SH) patients. It used data from all patients admitted to four Swiss EDs between 2016 and 2019. Socio-demographic, clinical, and suicidal process-related characteristics data were evaluated against the decision for voluntary or compulsory hospitalization using t-tests, Chi-Square tests and logistic multiple regression. 2142 episodes from 1832 unique patients were evaluated. Independent predictors of decision to hospitalize included: male gender, advanced age, hospital location, depression and personality disorders, substance use, a difficult socio-economic condition, a clear intent to die, and a serious suicide attempt. Significant variables that emerged as independent predictors of compulsory hospitalization were hospital location, not having anxiety and personality disorders, being retired, having a clear intent to die, and making a serious suicide attempt. Hospital EDs had different rates of compulsory psychiatric admission. However, the decision to admit a patient for hospitalization, either voluntary or compulsory, was mainly based on clinical factors.

[Relevance of interventions and support for relatives of an individual who made a suicide attempt]. / Importance de l'accompagnement des proches confrontés à une tentative de suicide.

Suicide and suicide attempt has an impact not only on the suicidal individual but also on his relatives. People expose to suicidal behavior of a close relation are confronted to death or to death threat and are subject to various signs such as anxiety, depression, specially linked to trauma. Therefore, it is essential to support those relatives in their suffering. Three types of intervention are distinguished according to timing: immediate, post-immediate and mid-to-long term interventions.

Le suicide avéré et la tentative de suicide ont un impact important sur la personne suicidaire mais aussi sur ses proches. Ces derniers se voient confrontés à la mort ou à une menace de mort, ce qui peut entraîner la survenue d'une panoplie de syndromes dépressifs et anxieux, surtout liés au traumatisme. Il est essentiel d'intervenir auprès des proches pour accompagner la souffrance psychique souvent présentée. Les interventions proposées sont subdivisées en trois temps distincts : interventions immédiates, postimmédiates et à moyen, voire à long terme.

[The health equity issues of an emergency department fee]. / Instauration d'une taxe aux urgences : enjeux d'équité en santé.

In June 2021, the Swiss parliament accepted a legislative proposal calling for the introduction of a fee to fight emergency department (ED) overcrowding. Although this issue remains a major challenge for health policies, the introduction of such a fee raises many questions, notably regarding health equity. However, other more equitable solutions exist: improving the case management of ED frequent users and improving coordination between ED and primary care.

En juin 2021, le Parlement fédéral a accepté une proposition législative demandant l'instauration d'une taxe aux urgences pour lutter contre leur surfréquentation. Bien que cette problématique demeure un enjeu majeur des politiques de santé, l'instauration d'une telle taxe pose de nombreuses questions, notamment d'équité en santé. Pourtant, d'autres solutions existent, en améliorant la prise en charge des usager-ère-s fréquent-e-s des urgences, ainsi que la coordination entre soins primaires et services d'urgences.

The Impact of COVID on Adolescent Mental Health, Self-Harm and Suicide: How Can Primary Care Provider Respond? A Position Paper of the European Academy of Pediatrics.

Adolescents aged 10 to 19 live a period of their life marked by opportunities and vulnerabilities during which the issue of mental health is of prime importance. Since several decades, and especially since the start of the COVID pandemic, mental health problems and disorders among adolescents have increased around the world. Depression, self-harm and suicidal behavior are common during this period of life, and pediatricians can play a pivotal role in identifying affected or vulnerable youngsters. This article describes risk factors for self-harm and suicidal behavior and reviews how primary care pediatricians and health professionals can respond to such situations. This scoping review is based on existing evidences as well as the authors clinical experience. It suggests concrete actions that can be taken to secure the life of at risk teenagers, and discusses how to organize the transfer to mental health professionals when needed.

Observational study of suicide in Switzerland: comparison between psychiatric in- and outpatients.

AIMS OF THE STUDY: In Switzerland, suicide is a major cause of years of potential life lost. Among people who died by suicide, a significant number suffered from mental illness and were treated by psychiatric care institutions. Psychiatric patients are thus a specific target for suicide prevention. Based on data from a clinical committee reviewing every death by suicide of psychiatric patients in the Canton of Vaud (Switzerland), this observational study aimed to gain knowledge on sociodemographic and clinical characteristics of psychiatric patients who died by suicide by comparing in- and outpatients. METHODS: Sociodemographic and clinical characteristics of patients who died by suicide in our department from January 2007 to December 2019 were analysed. In- and outpatients were compared. RESULTS: The sample included 153 patients (64.7% males, n = 99). Three quarters (76.4%, n = 81) of the patients had at least one previous suicide attempt. In- and outpatients did not differ significantly in terms of sociodemographics data, psychiatric diagnosis or method of suicide. Almost all (97.2%) of the outpatients had at least one past psychiatric hospitalisation. We found gender disparities for several variables and a lower male/female suicide ratio than in the general Swiss population. Seventy-two percent of the outpatients (n = 49) had a last personal contact with clinicians less than a week before their suicide and 38.8 % of those less than 24 hours (28% of outpatients, n = 19). CONCLUSIONS: Patients dying by suicide present most of the time a serious psychiatric history. In- and outpatients seem to have a similar clinical and sociodemographic profile and suicide prevention should thus not be addressed differently in these two groups. The time between death of outpatients and last contact with a therapist was shorter than expected.

[Psychiatric liaison II: training]. / La liaison psychiatrique II : formation.

Training provided by liaison psychiatry has been considerably developed over the last decades. This article describes how " communication skills" training in oncology evolved to now address interpersonal dimensions of the medical encounter, the clinician's "inner" world and the context. We further present a so-called clinician-centered supervision, which aims to address the intra psychic issues of the clinician; the opportunities and precautions with this specific type of supervision are discussed. Focusing on the clinician facilitates and enriches the clinical encounter and improves medical care.

La formation dispensée par les psychiatres de liaison s'est considérablement développée ces dernières décennies. Cet article présente le cas des formations à la communication en oncologie, en détaillant pourquoi et comment elles ont évolué d'un enseignement centré sur des compétences en communication (skills) à un travail sur la dimension relationnelle de la rencontre, l'étude des mouvements intrapsychiques et une attention portée au contexte. Il décrit ensuite la supervision centrée sur la ou le clinicien·ne, utilisée aujourd'hui à titre exploratoire, en soulignant les opportunités et les précautions nécessaires à sa pratique. Ces exemples montrent en quoi une psychiatrie de liaison qui porte aussi son attention sur le ou la clinicien·ne facilite et enrichit la rencontre clinique et améliore les soins.

[ASSIP: A new therapy following suicide attempt]. / ASSIP : nouvelle modalité thérapeutique après un geste suicidaire.

Although patients attempting suicide represent a highly vulnerable population, are often reluctant to care and at high risk of repetition, no specific therapy exist for them in French-speaking Switzerland. ASSIP® (Attempted Suicide Short Intervention Program) fills in this gap. It is a short therapy developed in Bern and being currently implemented in French-speaking Switzerland with the support of the Foundation « Promotion santé suisse ¼ (Swiss health care promotion). ASSIP® intervention is patient-centered and based on a narrative and behavioral approach and reduces suicide reattempts. It aims to jointly understand patient's suicidal process and to help him/her developing personal strategies to prevent repetition and manage future suicidal crisis.

En Suisse romande, les personnes ayant fait une tentative de suicide n'ont actuellement pas de prise en charge thérapeutique spécifique, alors qu'il s'agit d'une population particulièrement vulnérable, souvent réticente aux soins et présentant un risque élevé de récidive. Pour combler ce manque, une thérapie brève en quatre séances élaborée à Berne (l'Attempted Suicide Short Intervention Program (ASSIP)) est en cours d'implantation avec le soutien de la fondation Promotion santé suisse. Proposée en parallèle du traitement habituel, l'ASSIP est basée sur une approche narrative et cognitivocomportementale, centrée sur la personne. Efficace pour prévenir la récidive suicidaire, cette intervention vise à mieux comprendre le processus suicidaire et à permettre aux patients de développer des ressources afin de prévenir et d'agir lors d'une prochaine crise suicidaire.

[The gender paradox in suicide : some explanations and much uncertainty]. / Le paradoxe du genre dans le suicide : des pistes explicatives et pas mal d'incertitudes.

Men die more by suicide than women, but women attempt suicide more frequently. Gender does indeed shape suicidal ideas and behaviors. Due to differences in the way men express their suffering, men's depression may be underdiagnosed and undertreated. Furthermore, regarding suicidal behaviors, men use more lethal suicide methods than women. Their suicidal process seems also to progress more rapidly, which is probably related to their frequent substance use. Clinicians and researchers should consider these differences in their approach, without reducing men and women to their gender.

Le paradoxe du genre dans le suicide renvoie au fait que les hommes se suicident plus que les femmes, alors que ces dernières font plus de tentatives de suicide. Ce phénomène s'expliquerait par l'influence du genre dans ce qui détermine les idées et les conduites suicidaires. Des manifestations différentes de la souffrance psychologique pourraient d'abord conduire à un défaut de reconnaissance des dépressions masculines. Ensuite, au niveau même des comportements suicidaires, les hommes optent pour des moyens plus létaux et l'évolution de leur processus suicidaire est plus rapide, entre autres en lien avec le fait qu'ils consomment plus fréquemment des substances. Les cliniciens et les chercheurs devraient prendre ces différences en considération dans leur approche, sans réduire hommes et femmes à leur appartenance de genre.

Patients with first versus multiple episodes of self-harm: how do their profiles differ?

BACKGROUND: Self-harm (SH) is among the strongest predictors of further episodes of SH, suicide attempt, and death by suicide. People who repeteadly harm themselves are at even higher risk for suicide. Factors influencing the repetition are important to identify when assessing suicidal risk and thereafter to offer specific interventions. Therefore, this study aimed to compare first versus multiple episodes characteristics in a large sample of patients in french-speaking Switzerland. METHOD: We used the database from the French-speaking Swiss program for monitoring SH. Data of the psychiatric assessment of all adults admitted for SH were collected in the emergency department of four Swiss city hospitals between December 2016 and October 2019. RESULTS: 1730 episodes of SH were included. Several variables were significantly associated with multiple episodes, including diagnosis (over representation of personality disorders and under representation of anxiety disorders), professional activity (Invalidity insurance more frequent) and prior psychiatry care. CONCLUSIONS: Patients suffering from a personality disorder and those with invalidity insurance are at risk for multiple episodes of SH and should be targeted with specific interventions.

[Physicians, their practice, and the institution : to adapt or to situate oneself ?] / Le médecin, sa clinique et l'institution : s'adapter ou se situer ?

The context of the clinical encounter, and more generally of the practice of medicine, has effects on physicians. For example, it shapes their opinions, discourses, and ultimately their behaviors. The context may also directly impact physicians, sometimes affecting their physical and mental health. Numerous interventions, provided within and outside the institution, are targeting these effects. The question we raise in this article is: should physicians adapt to, or should they rather situate themselves within, their context. This question leads us to discuss reflexivity and reflexivity training.

Le contexte du médecin, « ce qui entoure ¼ la rencontre clinique et, plus globalement, sa pratique, produit des effets sur lui, par exemple en orientant, déterminant et modelant ses opinions, ses discours et sa conduite. Ces effets peuvent se révéler délétères et atteindre les médecins dans leur santé physique et psychique. De nombreuses interventions et formations sont aujourd'hui ciblées sur ces effets et proposées dans et hors institution. La question que nous posons dans cet article est de savoir si les médecins doivent apprendre à s'adapter à leur contexte ou, plutôt, à s'y situer. Cela nous amène à traiter du processus de réflexivité et des formations à la réflexivité.

[The physician, the clinical practice, and the institution: the suicidal patient]. / Le médecin, sa clinique et l'institution: le cas du patient suicidaire.

Patients and their clinical predicaments have an impact on clinicians (that psychoanalysis frames as countertransference), but also on medical institutions. Suicidal patients provide a potent illustration of such phenomena. At the individual level, they evoke intense, often negative affective reactions. At the institutional level, they are also « difficult ¼ patients, who often do not conform to the classical, « expected ¼ sick role. This can result in policies too focused on risk assessment and strict procedures, potentially detrimental to proper care. To prevent such defensive attitudes, institutions should provide clinicians an environment in which they are able to work through their relationships with patients, but also with the medical profession and institutions.

Parallèlement à ce qu'ils éveillent chez les cliniciens ­ les psychanalystes parlent de contre-transfert ­, les patients ont des effets sur l'institution. La suicidalité en fournit un bon exemple. Au niveau individuel, la rencontre avec les patients suicidaires suscite des affects intenses et souvent négatifs. Au niveau institutionnel, ces patients, difficiles, rappellent les suicides passés et leurs effets traumatiques; ils peuvent être ambivalents vis-à-vis des soins et ne se conforment pas au rôle « attendu ¼ des malades. En réaction, on peut observer des mouvements délétères, comme le développement de procédures trop focalisées sur l'évaluation du risque. Pour les prévenir, l'institution doit offrir aux cliniciens qui la font et la soignent un cadre pour penser leur relation aux patients, au métier et à l'institution elle-même.

Patient perspectives on an intervention after suicide attempt: The need for patient centred and individualized care.

BACKGROUND: Many types of intervention exist for suicide attempters, but they tend not to sufficiently consider patient's views. AIM: To identify useful components of a previously evaluated intervention after a suicide attempt from the patient's views and to better understand the process of recovery. METHOD: Forty-one interviews with suicide attempters were qualitatively analysed. Views of participants (i) on the components of the intervention (nurse case-management, joint crisis plan, meetings with relatives/network and follow-up calls) and (ii) their recovery were explored. The material was analysed by means of thematic analysis with a deductive-inductive approach. RESULTS: Participants valued the human and professional qualities of the nurse case-manager, and appreciated follow-up calls and meetings. However, their views diverged regarding for instance frequency of phone calls, or disclosing information or lack thereof. Interpersonal relationship, suicide attempters' own resources and life changes emerged as core recovery factors. DISCUSSION: The study highlights the figure of an engaged clinician, with both professional and human commitment, aware that some suicide attempters put more emphasis on their own resources than on delivered health care. CONCLUSIONS: Interventions should consider the clinician as the cornerstone of the tailored care valued by suicide attempters.