Mental health status of individuals with sexual development disorders: A review.

Healthcare recommendations for people with disorders of sexual development (DSDs) include mental health attention and active participation of psychiatrists and psychologists in dedicated multidisciplinary teams. Therefore, it seems crucial for them to improve knowledge about specific difficulties and needs of these patients. The aim of this article is to report in a synthesizing manner the recent works evaluating the mental health and psychological status of individuals with DSDs. After research conducted using PubMed and ScienceDirect, 18 studies were inventoried and qualitatively analyzed in response to three main questions: Do individuals with DSDs suffer more frequently and/or more severely from psychological conditions or mental disorders? From what kind of disorder do they suffer? and What are the determinant factors involved in their development? This work highlights an increased risk of affective disorders in individuals with DSDs, particularly anxiety and depressive disorders and interpersonal difficulties. Studies identified some potentially determining factors implicated in their development, among which are the etiology of DSDs, the life stage, the age at the time of diagnosis, and the lack of conformity of sexual phenotype with sex assignment. Taken together, the etiology of DSDs, the lack of conformity of sexual phenotype with sex assignment, and the feeling of being different from peers seem to be interesting factors to study in the future. Multicentric and longitudinal studies using standardized evaluation and control groups should be the most robust way to improve knowledge about these preoccupations.

Assessment of conversational pragmatics: A screening tool for pragmatic language impairment in a control population of children aged 6-12 years.

Pragmatics can be defined as the way in which language is used to communicate in a given social context. Although there is a lack of a standardized assessment, healthcare professionals find themselves confronted with pragmatic language skill impairments in children with neurodevelopmental disorders or brain injuries. The characterization of language use causes problems in social interactions, which has clinical implications in daily life. However, this is still underestimated because there is currently no quick, easy-to-use screening device to rank these deficits. We have developed a pragmatic deficits screening chart that has been tested on a control population of children aged 6-12 years. The chart comprises 26 items exploring seven areas of pragmatics (intentionality, governance of exchange, organization of information, adaptation strategies, conversational implicit language, nonverbal skills, and paralinguistic aspects). Parents select one of four possible answers to describe how frequently their child demonstrates each type of behavior ("never, rarely, sometimes, often"). We distributed 1666 charts; 760 were returned, of which 552 could be analyzed. Internal consistency as measured with Cronbach's alpha coefficient (0.88) was satisfactory. There was no influence of age on total score, nor of the department/type of schooling. The population distribution was non-Gaussian so the results are presented in percentiles. We propose a first-line screening tool that is quick and easy to complete by family, which facilitates referral to specialists for further investigations into the etiological implications of pragmatic language impairment.

[Socio-demographic and clinical characteristics of adolescents hospitalized in French units for inmates: Results of a cross-sectional study]. / Caractéristiques socio-démographiques et cliniques des adolescents détenus hospitalisés en unité hospitalière spécialement aménagée : résultats d'une étude transversale nationale.

BACKGROUND: In France, on the first of January 2018, 772 underage persons were in jail or about 1.1 % of the incarcerated population. The prevalence of psychiatric disorders among those inmates is high. As a result psychiatric care (and particularly full-time hospitalization) is essential for this population. The unités hospitalières spécialement aménagées (UHSA) are full-time inpatient hospitalization units for inmates in France. Adults but also underage inmates can be admitted to UHSA for voluntary or involuntary hospitalization. However, no study about the characteristics of young patients admitted to UHSA is currently available. The aim of this study is to describe the population of children and adolescent patients hospitalized in these facilities and to evaluate the care provided. METHOD: We conducted a retrospective study, including all the patients under 18 years of age, who have been hospitalized in UHSA since its creation in 2010 until 31 December 2016. Anonymized data concerning socio-demographic profile, clinical symptoms and care provided have been collected from the medical records of each patient. RESULTS: Overall 80 underage patients were included, for 120 hospitalisations in UHSA. Those patients are mainly male (80%) with a mean age of 16.7 years. They are mostly hospitalized with their consent (59%) for stays of about 50 days and frequently after self-harm behaviours. The main diagnoses are anxiety disorders (26%) and psychotic disorders (25%). At the end, 86% of the patients are prescribed a psychotropic drug treatment and 40% of those medical drugs are prescribed outside the guidelines. Finally, several specific problems were identified. Especially, contact with families and educators or access to education programs are very challenging. CONCLUSION: This study highlights the current difficulties encountered in the management of inmate underage patients in full-time psychiatric hospitalization. In this paper, we propose areas for improvement through (1) specific arrangements to receive young patients (specific service's management in order to reinforce the observation of those young people, to facilitate contact with their families, to improve the access to education programs, etc.); (2) specific arrangements in the treatment offered to young patients in UHSA (specific training course for nurses, specific therapeutic programs, etc.); (3) the development of networks working with psychiatric services inside and outside the prison, educators, families and prison services, in order to promote the continuity of cares.

[Relevance and experience of surveillance and brief contact intervention systems in preventing reattempts of suicide among children and adolescents]. / Pertinence et expérience des dispositifs de veille et de recontact dans la prévention suicidaire auprès des enfants et des adolescents.

In France, one adolescent out of ten has already attempted suicide. In this population, suicide reattempts are frequent and significantly impact the vital, morbid and functional long-term prognosis. For about fifteen years, surveillance and brief contact intervention systems (SBCIS) have been used to complete the French suicide reattempt prevention arsenal for youth. The relevance of such strategy appears once the mental health service gap observed at this period of life is considered. In addition to prompting better coordination between the different professional stakeholders, the SBCIS help to alleviate the adolescent's help-seeking barriers, especially the ambivalence between conquest of autonomy and need for help. The first results from the French SBCIS dedicated to children and adolescents are encouraging. Although they have to deal with specific challenges, we argue that they relevantly complement and potentiate the already available prevention resources, thus optimizing the whole prevention system for suffering youth.

[Consultation liaison during the peripartum: Network care between liaison and mobile unit]. / La liaison en « Périnatalogie ¼ : des soins entre réseau, liaison et prise en charge mobile.

OBJECTIVES: The pregnancy periods of peripartum and immediate postpartum represent moments of opportunity to access care. Both prevention and therapeutic management can be offered with a better chance of success during these periods. Our specific Consultation Liaison (CL) team PPUMMA was created in order to respond to the need for early detection of psychopathology and rapid implementation of therapeutic management and preventive measure for mother and child. The importance of urgently intervening "on site" seemed a necessity since duration of hospitalization in maternity wards is very short. Women might not know or understand their symptoms or be ready to ask for a referral for themselves but could be ready to respond positively to a team approach where the psychiatrist is part of the Ob-Gyn department. Working with an interdisciplinary approach tends to lower stress linked to the psychiatric side of the consultation and stigma related to psychological or psychiatric issues; therefore, PPUMMA intervenes within 48 to 72hours of birth. It deals with assessment and diagnosis during the peripartum period and orientation and referral for both mother and infant when necessary after birth. The Perinatal Psychiatry emergency mobile unit PPUMMA was created in order to address these issues. METHODS: From 2008 to 2015, 1907 patients were assessed but data were missing for 90 patients. We therefore analyzed 1817 patient files looking at age, diagnosis origin of referral, time of referral (pre or postpartum) and delay from referral to assessment. RESULTS: Most patients were between 20 and 40 (81.5 %). One hundred and eighteen patients were under 20 years of age, of whom 64 were minors (3.5 %), and 218 were 40 or more (12 %). These two groups were over-represented close to threefold when comparing with national birth data records. A psychologist had first seen three out of four women. Midwives and Ob-Gyn referred 9 % and 8 % of patients while Social workers sent in 4 %. Two thirds of the women were seen during pregnancy, 50 % were seen the same day and 80 % received a consultation within 72hours. Three out of five of women had an assessment that concluded in a "Neurotic, stress-related and somatoform disorders" type code disorder linked to stress and somatoform disorder in ICD 10 (F40-F49). This is due to a high number (47.2 %) of F43 "Reaction to severe stress, and adjustment disorders". Twentynine present of women had a mood disorder (F30-39), and close to one third (31.6 %) had a personality disorder diagnosis attached. Schizophrenia, schizotypal and delusional disorders (F20-F29) represented 4.4 % of diagnoses. One third of the population had comorbid disorders: meeting either two (28.5 %) or three (3.7 %) diagnostic criteria for a psychiatric disorder. Most co-morbidity is due to personality disorder (82 % F60-F69). CONCLUSION: The number of referrals and diagnostic criteria met show how essential a psychiatric CL team assessing and orienting women during pregnancy and immediate postpartum is. Opportunity for adaptation of treatment during the peripartum period and more long-term tailored management of disorders can be organized during this period in a multidisciplinary approach. Knowing how essential maternal mental health is for women, for infant development and for mother-infant interactions, this is a unique window for access to care and intervention. Maternal mental health is a public health issue. Access to psychiatric assessment and care during the peripartum period offers unique possibilities for prevention and care.

[Neuropediatric approach to autism]. / Approche neuropédiatrique de l'autisme.

Autism is defined by 3 main criteria: disturbance of reciprocal social interaction, disturbance of communication (including language comprehension and spoken language) and disturbance of normal variation in behaviour and imaginative activities; an onset before age 36 months is also required. The neuropediatric contribution to autism is dominated by the search for an underlying organic etiology, especially if there are arguments for an associated encephalopathy: ante- or perinatal medical history, dysmorphic signs, skin spots, neurological abnormalities, somatic abnormalities compatible with a neurometabolic disorder. The main associated conditions with autism are: chromosome anomalies, monogenic syndrome (including fragile X syndrome), neurocutaneous syndromes, epileptic encephalopathies, neurometabolic diseases, and dystrophinopathies. The identification of an associated medical condition to autism is primordial in prospect of genetic counselling, and by the change induced in familial perception of autism.