Mental health care utilization by first responders after Paris attacks.

BACKGROUND: First responders (FRs) are frequently exposed to potentially traumatic events, including terror attacks, and may consequently be at risk of developing mental health disorders. Prior research suggests that FRs with mental health disorders often do not receive appropriate treatment. More knowledge is needed about their use of mental health care (MHC). AIMS: This study aimed to identify factors associated with receiving immediate support, post-immediate support and engagement in MHC among FRs of the November 2015 terror attacks in Paris. METHODS: A web-based study was conducted 8-12 months after the attacks on 663 FRs who were mobilized during the night and/or the aftermath of the attacks. Logistic regression was performed to analyse factors associated with MHC. RESULTS: Overall, 44 FRs sought MHC. Among FRs with post-traumatic stress disorder (PTSD), partial PTSD or depression (n = 60), 38% sought MHC (n = 23). Post-immediate support was associated with immediate support, and both were associated with knowing someone who could help regarding the potential psychological risks following a traumatic event. MHC engagement was associated with a history of MHC, post-immediate support and the presence of PTSD, partial PTSD or depression. CONCLUSIONS: Among FRs with PTSD, partial PTSD or depression, few sought MHC. Improved access to MHC for FRs after terror attacks is essential. Knowing someone who could help regarding potential psychological risks may facilitate immediate and/or post-immediate support. Furthermore, post-immediate support could encourage engagement in MHC. Efforts should be made before and after potentially traumatic events to ensure mental health education for FR.

[Age at diagnosis of Autism Spectrum Disorder depending on ethno-cultural background or migratory status: A systematic literature review]. / Âge au diagnostic de trouble du spectre autistique en fonction de l'appartenance à une minorité ethnoculturelle ou du statut migratoire, une revue de la littérature systématisée.

INTRODUCTION: The early identification and access to health care of toddlers with autism spectrum disorder (ASD) - or at risk of developing it - is a crucial public health issue, as care and intervention may be more effective in younger children in order to improve their development and prognosis. However, there are still disparities in identification and health care access for children with ASD despite better screening methods. Given that misdiagnosis and delayed diagnosis are often due to the cultural gap between clinician and patient in some psychiatric disorders such as depression or schizophrenia, we examined this question concerning ASD and wondered to what extent ethno-cultural or migratory status might have an impact on the age at which a child is diagnosed. The only published review looking for independent factors influencing age of diagnosis concludes that the factors that have been proved to play a role are: socioeconomic status; symptom severity; level of parental concern, and family interactions with the health and education systems prior to diagnosis. The impact of ethno-cultural or migratory status is less clear. And yet, all these factors may be interconnected: migrants have on average a lower socioeconomic status, minorities don't have the same access to health care, and cultural background can have an influence on what is expected of a child's development and health. In order to try and clarify this issue and to analyze the way in which the international literature approaches the subject, we carried out a systematic review. METHOD: Six databases were interrogated: Pubmed, Embase, Psychinfo, WebOfScience, Cochrane and Cinahl using the key words "ASD", "pervasive developmental disorder", "diagnosis", "age", "migrant", "ethnicity", "cross cultural". We narrowed neither the period of time not selected the articles by their method, as our objective was to collect the entirety of the articles written on the subject. We completed this review by including the pertinent references made in the articles. RESULTS: Twenty articles were included, all epidemiological and observational, about children diagnosed in specialized centers. Published between 2002 and 2019, they cover a 20-year research period, between 1992 and 2016. The methods are disparate: the diagnosis criteria used are from DSM IV, IV TR and ICD; data originate from medical records, phone or internet surveys, and Medicaid healthcare claims. Comparison of the age at diagnosis is the principal objective for only thirteen studies; statistical data analyses vary, especially concerning adjustments. Seventy-five percent of the articles originate from North America where the compared populations are defined by ethnic and racial categories that are not used in some other countries, notably in Europe. Only five explore the link between migratory status and age at diagnosis. The research results concerning the impact of ethnicity are contradictory, while those concerning migratory status seem to indicate that migrant children are likely to be diagnosed later. But the articles and their methods being too heterogeneous, it was difficult to make a meta-analysis and impossible to reach a scientific conclusion. CONCLUSION: Nevertheless, this review highlights the existence of a lot of confounding factors and raises many issues. It shows that the United States produces most of the studies whose conclusions cannot be generalized because of the particular history and organization of this country. In Europe, where belonging to minority groups is thought to be through migratory status, studies are rare. There is an urgent need for new research in order to clarify the connection between migratory status and socioeconomic factors, to precisely define the independent variables influencing diagnosis -such as access to healthcare- and finally to explore the possibility of different symptomatic expressions depending on cultural backgrounds. This review falls within studies currently carried out by the psychiatric service at Avicenne hospital in Bobigny, France about ASD in a transcultural context.

[Suicidal behaviors in migrant youths: Male experiences]. / Comportements suicidaires à l'adolescence en situation de migration : expériences masculines.

OBJECTIVES: Suicide is the second leading cause of death among adolescents. Boys are more affected than girls, although they report fewer suicide attempts and rely less on care. Few studies have examined the experience of suicidal thoughts and behavior among young boys. In order to improve their health care, it is necessary to consider the socio-cultural aspects and the construction of the meaning given by adolescent boys to suicidal behaviors in France. METHOD: This is a qualitative, complementary and inductive study. All teens included have presented suicidal thoughts in the months preceding the inclusion. The existence of self-mutilation and/or suicidal act is sought but is not included within the criteria of inclusion, the various contexts will enrich the data. Semi-structured interviews are transcribed and analyzed by the Interpretative Phenomenological Analysis. RESULTS: Ten adolescents between 14 and 20 years old were included in the study. Three axes of experience emerge: the relationship to oneself, the relationship to the other, the relationship to death. Some themes are common to experiences of both boys and girls, others are more specific to the boys' experience. The inner struggle, testing one's limits and an isolating unspeakable are thus common, highlighting the difficulty for adolescents to mentalize and verbalize emotions and feelings. Difficulties in connecting with others, and feelings of loneliness and isolation, are at the core of the participants' experience. However, the experience of boys appears specific in the difficulty to represent the irreversibility of death which can lead to suicidal behavior without direct intentionality. The narrative of suicidal acts, in its formulation, is quite different from that of young girls. One can assume that the difficulty of expressing suffering could lead young boys to develop a discourse that overshadows the question of their death, or in contrast magnifies it in a rewarding stage from which they pride themselves. The fear of being isolated or rejected seems almost insurmountable for the boys interviewed. The fear of the judgment of peers or the family is mixed with the imperative to face the problem by oneself and reinforces the feeling of isolation in a retroactive loop. The story of the suicidal act can take a positive and enriching tone in the participant's stories. This only applies to adolescents with a history of suicidal gesture. The experience of acting out and its consequences seems to be integrated by the adolescent as elements which participate to a certain extent to the construction of their identity. This ameliorative feature can be compared to the hegemonic social models of masculinity. The sociological notion of gender identity makes it possible to think of this construction in a dynamic way and to propose adaptations of the caregivers' attitude during the first interviews with a suicidal teenager. During the first meetings, the caregiver should explore the adolescent's representations of the suicidal crisis in a neutral, self-interested, and unbiased way, including when the representations are disturbing or shocking for the caregiver. For example, when the patient values or glorifies suicidal behavior or when care is experienced as a sign of weakness and vulnerability. Respect of these proposals can indeed support weakened narcissistic foundations and favor encounter and alliance. This can only be done with the conviction that these representations are not frozen, but in construction, and that they can be secondarily mobilized in the therapeutic relationship. For that purpose, a work of elaboration on the representations of the masculinity will be able to lead the young person to reconsider his perception of care and suicidal behaviors. Reflexivity on the part of the caregiver about his own representations of masculinity seems necessary. CONCLUSION: Therapeutic management must explore and respect the adolescent's representations of masculinity and then mobilize them to bring the young person to reconsider his perception of care and suicidal behavior.

How to stay in touch with adolescents and young adults after a suicide attempt? Implementation of a 4-phones-calls procedure over 1 year after discharge from hospital, in a Parisian suburb.

OBJECTIVES: Post-discharge treatment is a major part of youth suicide prevention. However, many adolescents and young adults suicidal patients released from emergency department (ED) fail to follow through with subsequent outpatient psychiatric appointments. The aims were to (1) implement a one-year follow-up phone-call program for adolescent and young adults suicide attempters admitted at the ED (2) assess its feasibility (3) describe outcomes measures (repeated suicide attempt and observance of outpatient care) and (4) access risk factors to be out of sight at one year follow up and (5) elicit subjective feedback after one year, using narrative data. METHOD: A cohort of adolescents and young adults aged 15-21 years admitted to Avicenne University Hospital ED for suicide attempt (SA) was created and re-contacted using phone calls at one week, one month, six months and twelve months after discharge. Sociodemographic information was collected at baseline. At one year, qualitative data was collected from patients or their parents. RESULTS: One hundred and seventy-three adolescents and young adults were included. At 1 year, 93 young patients had been successfully contacted, among whom 23 had reattempted suicide, at least once. Adolescents and young adults that were unreachable at one year showed a higher rate of school dropout and had more migration history at baseline. Feedback showed that the intervention was experienced as supportive. CONCLUSION: Phone-calls after discharge from hospital might help enhance compliance to aftercare treatment, and were well-accepted by both adolescents and parents. Nevertheless, half of our sample was lost of sight at one year. Further studies are needed to find the most effective prevention strategy with young suicide attempters, especially for migrants and school droppers.

[Psychotic states in young migrants and children of migrants]. / Les états psychotiques chez les jeunes migrants et enfants de migrants.

Psychiatric literature documenting increased rates of psychotic illness among migrants in European countries has been more and more reported during the past two decades. Social causes to this phenomenon have been highlighted. In this paper, we review and discuss this literature from the cultural psychiatry perspective. We can point three limitations to these works : the definition of the studied groups, the cultural validity diagnoses, and the psychic impact of migration and its complexity not being considered enough. The above considerations lead us to go forward with studies addressing this question. The need to construct methodologies addressing psychiatric epidemiology, transcultural psychiatry and human sciences is underlined.

Addressing the mother-infant relationship in displaced communities.

Delivering appropriate care to refugee families requires complex care systems and models that take account of the social, cultural, and political dimensions as well as the psychologic dimension. Children born into these families are exposed to consequences of their own past experiences and also may be subject to the transmission of the traumas experienced by their parents. This exposure can lead to alterations in these children's individual creative resources. Early, tailored care should be provided for these families, so that the transmission of the trauma and its consequences can be managed or ameliorated.

[Apotemnophilia as a contemporary frame for psychological suffering]. / Apotemnophilie: une mise en forme contemporaine de la souffrance psychique?

UNLABELLED: The word <> was created in 1977. It was first used to describe an extreme paraphilia concerning both the search for amputees as sexual partners, and the fantasies and wishes to be amputated linked to a sexual arousal. CLINICAL FINDINGS: More recently, the number of self-demand amputations appears to have raised. Some amputations of healthy legs have even been performed in hospital settings, raising important ethical issues. A new category of trouble has been described: the Body Integrity Identity Disorder (BIID). Criterias for its diagnosis have been developed and submitted to DSM V task force. According to clinicians who support the existence of BIID, this disorder is not a paraphilia, don't overlap with other psychiatric disorders and could be in some ways compared to transexualism. The patient's health would therefore require the amputation of healthy limbs in order to <> themselves and to help them to become <> according to their <>. Still according to those clinicians, psychiatric symptoms would be either a consequence of the shame resulting from this condition, or a consequence of the doctor's refusal to perform these amputations. An ever growing <> litterature on the web support this opinion, but the scientific litterature is still very scarce. LITERATURE FINDINGS: In this paper, we analyse available scientific datas. This review does not support the existence of BIID as a discrete nor a specific condition. CASE-REPORT: In a second part of this paper, we describe the case of a young woman who started asking for above-the-knee leg amputation after a minor knee trauma, while complaining for pain and leg rigidity. Her medical state worsened, probably because of repeated self-inflicted lesions and food restriction, leading to a severe undernutrition and life-threatening hypokaliemia. After some time, her medical state required amputation. This surgery did not resolve her psychological suffering. She never talked about amputation as a way to achieve herself. She did not meet the criterias for BIID. We consider her trouble as an association of a factitious disorder with a borderline personality disorder. DISCUSSION: In the last part of this paper, we discuss the <> scientific litterature about apotemnophilia and BIID. We support the idea that BIID can be considered as a culture-bound syndrome, a contemporary frame for psychological suffering. We think that BIID does not have neither intrinsic nor unequivocal psychopathological meaning. It is a <> (Elliott), a common pathway for the expression of very different kinds of psychological suffering. CONCLUSION: Apotemnophilia and BIID are raising important ethical and practical issues for psychiatrists: their opinion will probably be requested by patients and surgical teams having to deal with patient asking for healthy limbs amputation.

[Finding a meaning for illness: from medical anthropology to cultural epidemiology]. / Donner un sens à la maladie: de l'anthropologie médicale à l'épidémiologie culturelle.

Every illness raises questions concerning its causes and even more its meaning. Why me? Why him? Why now? These questions call for an interpretation which goes beyond a simple application to the individual body and the medical diagnosis. This search for meaning is by no means an archaic attitude and does not only concern the cryptic fields of medicine as several studies in medical anthropology and transcultural psychiatry have shown. A review of literature in anthropology points out the basic concepts of "health care system", "explanatory models", "etiological theories", and "causality of illness". The contribution of these studies to epidemiology and public health of infectious and tropical diseases is discussed through the development of so called cultural epidemiology based on the methodology of the Explanatory Model Interview Catalogue.

[Serotonin syndrome: critical review of the literature]. / Le syndrome sérotoninergique: revue critique de la littérature.

Since Sternbach's first review, serotonin syndrome has been reported many times. Our purpose was to examine this concept's pertinence, utility and meaning. Its physiopathology remains unclear: 5-HT1A receptors activation is certain, but others mechanisms and individual or family factors could be also involved. Appearance circumstances are more various than first expected. The concept of serotonin syndrome seems to bring together entities that differ in physiopathology and seriousness, and we propose to distinguish between serotonin syndrome and other types of syndromes. Knowing serotonin syndrome is useful both for prevention and for recognizing it as a potentially lethal emergency.