Disclosure of sexual abuse by adolescents treated in a psychiatry department.

OBJECTIVES: The aim of the study is to describe the population of adolescents who have disclosed sexual abuse to a health professional during their care in a psychiatric department. We also want to discuss the circumstances that enable adolescents to make this disclosure. METHODS: This single-center retrospective observational study is based on the mandatory reports (n=139) sent by a Paris adolescent psychiatry department between 2005 and 2021 after patients disclosed previous sexual abuse. R® (3.6.1) and RStudio® (1.2.5001) software were used for statistical analysis. RESULTS: Girls accounted for almost all the adolescents who disclosed (95.7%). First abuse occurred around the age of 12 years and was first disclosed to a health professional a mean of 3.5 years later; 66 (47.5%) patients were admitted for inpatient care during their follow-up. The most common diagnoses were depression, eating disorders, posttraumatic stress disorders, and other anxiety disorders. Before disclosing to a health professional, most of these adolescents had already talked about it, mainly to a family member (69.8%) or peers (24.7%). CONCLUSION: This is the first study in France on the reporting of sexual abuse after its disclosure by adolescents being treated in a psychiatry unit. Our results show that child sexual abuse is rarely reported and that health care professionals are far from being the first recipients of these disclosures. We recommend routine screening for sexual abuse in adolescent psychiatry units, improved training for staff receiving these disclosures, and consideration of how best to coordinate medical, social, and legal services for these adolescents.

Vegetarianism and eating disorders: The subjective experience of healthcare professionals.

Vegetarianism is growing dramatically among adolescents and young adults. Professionals specialized in eating disorders (ED) may routinely face patients adhering to these popular vegetarian practices. This qualitative study aimed to investigate healthcare professionals' subjective experience of vegetarianism in ED patients. Interviews of practitioners specialized in ED, recruited from the French federation of anorexia and bulimia (FFAB), were conducted using a semi-structured guide. We reached data saturation. Thematic analysis was used to identify and analyze patterns of meaning in the dataset. Eighteen professionals (dieticians, physician-nutritionists, and a psychiatrist) with private or institutional practices were interviewed. Three meta-themes emerged from our thematic analysis: (1) heterogeneous perceptions of vegetarianism among healthcare professionals, (2) diverse nutritional care practices, (3) factors influencing professionals' nutritional strategies and approaches. This original qualitative and exploratory study reported vegetarianism is a fast-growing phenomenon observed in a majority of adolescent patients with anorexia nervosa, with various underlying motivations reported. In all cases, the nature of the timing and relation between the vegetarian practices and the ED should be carefully assessed, using specific tools. Because of the ethical dimension of this issue and the risk of professional bias, institutional policy based on specific practice guidelines, to be developed, are strongly encouraged.

How parents experience their adolescent's disclosure of previous sexual abuse: a qualitative study.

INTRODUCTION: Parents whom adolescents disclose sexual abuse face both a personal traumatic experience, and the need to support their child who is going through a grueling period and needs them. Many quantitative studies exploring the psychological impact of disclosure on parents have been conducted, but few have used qualitative methods. The objective of this study is to explore parents' experiences of their adolescent's disclosure of sexual abuse during psychiatric care, identify the possible beneficial factors and shortcomings, share this knowledge, and improve interventions for these families. METHODS: We conducted semi structured interviews with parents whose children disclosed sexual abuse during their psychiatric care in Paris and analyzed these interviews using a phenomenological framework (interpretative phenomenological analysis). RESULTS: This study analyzed 13 semi structured interviews of 9 mothers and 4 fathers whose children were then aged 14 to 17 years. Qualitative analysis uncovered three themes: (1) Parents: alerts and search for support; (2) Between parents and adolescents: a disruption in relationships linked to the disclosure and its legal consequences; (3) Disclosure at the family level: the possible reactivation of a traumatic past and the search for a new equilibrium. CONCLUSIONS: Considering the parental experience is essential in caring for adolescent patients after they disclose sexual abuse. The need for parental or family psychological support should be systematically assessed. Possible resurgence of parental trauma requires psychiatrists' careful consideration.

Recovery of Homogeneous Platinoid Catalysts from Pharmaceutical Media: Review on the Existing Treatments and the Perspectives of Membrane Processes.

Catalyst recovery is a major challenge for reaching the objectives of green chemistry for industry. Indeed, catalysts enable quick and selective syntheses with high reaction yields. This is especially the case for homogeneous platinoid catalysts which are almost indispensable for cross-coupling reactions often used by the pharmaceutical industry. However, they are based on scarce, expensive, and toxic resources. In addition, they are quite sensitive and degrade over time at the end of the reaction. Once degraded, their regeneration is complex and hazardous to implement. Working on their recovery could lead to highly effective catalytic chemistries while limiting the environmental and economic impacts of their one-time uses. This review aims to describe and compare conventional processes for metal removal while discussing their advantages and drawbacks considering the objective of homogeneous catalyst recovery. Most of them lead to difficulty recycling active catalysts due to their ability to only treat metal ions or to chelate catalysts without the possibility to reverse the mechanism. However, membrane processes seem to offer some perspectives with limiting degradations. While membranes are not systematically the best option for recycling homogeneous catalysts, current development might help improve the separation between pharmaceutical active ingredients and catalysts and enable their recycling.

Efficacy and tolerance of second-generation antipsychotics in anorexia nervosa: A systematic scoping review.

INTRODUCTION: Second-generation antipsychotics (SGAs) are frequently prescribed for the treatment of resistant anorexia nervosa. However, few clinical trials have been conducted so far and no pharmacological treatment has yet been approved by the Food and Drug Administration. The aim of this paper is to conduct a systematic scoping review exploring the effectiveness and safety of atypical antipsychotics in anorexia nervosa (AN). METHOD: We conducted a systematic scoping review of the effectiveness and tolerability of SGAs in the management of AN. We included articles published from January 1, 2000, through September 12, 2022 from the PubMed and PsycInfo databases and a complementary manual search. We selected articles about adolescents and adults treated for AN by four SGAs (risperidone, quetiapine, aripiprazole or olanzapine). This work complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRIMA-ScR) and was registered in the Open Science Framework (OSF) repository. RESULTS: This review included 55 articles: 48 assessing the effectiveness of SGAs in AN and 7 focusing only on their tolerability and safety. Olanzapine is the treatment most frequently prescribed and studied with 7 randomized double-blind controlled trials. Other atypical antipsychotics have been evaluated much less often, such as aripiprazole (no randomized trials), quetiapine (two randomized controlled trials), and risperidone (one randomized controlled trial). These treatments are well tolerated with mild and transient adverse effects in this population at particular somatic risk. DISCUSSION: Limitations prevent the studies both from reaching conclusive, reliable, robust, and reproducible results and from concluding whether or not SGAs are effective in anorexia nervosa. Nonetheless, they continue to be regularly prescribed in clinical practice. International guidelines suggest that olanzapine and aripiprazole can be interesting in severe or first-line resistant clinical situations.

Evaluation of the rapid implementation of telehealth during the COVID-19 pandemic: a qualitative study among adolescents and their parents.

The Coronavirus Disease 2019 (COVID-19) pandemic catalysed an abrupt explosion in the use telepsychiatry for the delivery of mental health services. We aimed to explore the experience of telemedicine use during this period among adolescent outpatients and inpatients and their parents. This qualitative study took place in a French adolescent medicine and psychiatry department during the first lockdown. Data collection by purposive sampling continued until we reached theoretical sufficiency. The interviews were analysed by applying Interpretative Phenomenological Analysis which is based on an iterative, inductive process. It included 20 participants: 10 adolescents and 10 parents. The analysis showed three themes: (1) facilitators of a switch from face-to-face to tele-consultation: (a) the context of health emergency, (b) the integration of parents in the treatment, (c) the choice between telephone or video consultation; (2) distance from the therapist's gaze and its consequences: (a) an obstacle to decrypting clinical nonverbal communication, (b) effectiveness depends on the severity of the adolescent's symptoms, (c) and on the previous quality of the therapeutic relationship; (3) awareness of the value of the face-to-face therapeutic space. In the post-COVID era, practitioners would benefit from combining both approaches, face-to-face and remote, based on the quality of the therapeutic alliance, the pathology, the parents' availability for in-person participation, and the patient's age. Future quantitative research will also be necessary to establish the extent to which the experiences described by the participants in this study reflect those of a broader population.

[The disclosure of sexual violence by adolescents: clinical and therapeutic complexity]. / Complexités face à la révélation de violences sexuelles par des adolescents.

Despite the frequency and traumatic impact of sexual violence, very few victims allow themselves to speak. Two clinical cases allow us to discuss the modalities of support for adolescents who reveal, during their psychiatric follow-up, that they have been victims of such violence.

The experience of anaesthesiology care providers in temporary intensive care units during the COVID-19 pandemic in France: a qualitative study.

BACKGROUND: During the COVID-19 pandemic, care providers (CPs) worldwide grappled with the extraordinary number of severely ill patients with high fatality rates. The objective of this study is to explore the experience of anaesthesiology CPs in temporary intensive care units during the COVID-19 pandemic's first wave. METHODS: CPs were interviewed at a university hospital in Paris, France. We conducted a qualitative study using interpretative phenomenological analysis. RESULTS: Fifteen participants were included (five nurses, three nurse managers, and seven physicians). The analysis uncovered four themes: 1. Overworked care providers in an intensive care unit under pressure; 2. The disrupted relationship among patients, their families, and end-of-life care; 3. Short-term coping strategies; 4. A long-term transformative experience for care providers. DISCUSSION: The COVID-19 pandemic has drained CPs physically and emotionally. Infection control protocols, lack of knowledge about this new disease, the establishment of open-space care settings, and the disruption of relationships have posed ethical dilemmas, leading CPs to question the meaning of their profession, and their future professional involvement. CPs at both an individual and institutional level employed numerous coping strategies, relying on a strong team spirit and a reinforced sense of duty. Nevertheless, after the end of the first wave, participants described the long-lasting psychological impact of this experience and frustration at the lack of recognition from their institutions and from policymakers. This study can inform institutional interventions and public health policy to support CPs during and after such a crisis to ensure their well-being and high standards of care.

Subjective Experience of Antidepressant Prescription Among Adolescents With Anorexia Nervosa.

Introduction: Major depressive disorder is considered the most common comorbidity of anorexianervosa in adolescence. Some evidence argues against antidepressant use in this population. Moreover, the fear of being threatened with autonomy and of becoming dependent specific to this adolescent population and at the very core of the anorexic disease, make the proposal of such a treatment difficult to accept. This qualitative research aimed to explore the perspectives of view of adolescents with anorexia nervosa about antidepressants. Methods: We conducted interviews with adolescents suffering from anorexia nervosa who had been treated with an antidepressant agent during their inpatient or outpatient care at Cochin Hospital. Adolescents were chosen by convenience sampling. Both verbal and written questions were asked to elicit their lived experiences. Interpretative Phenomenological Analysis was used to examine the data. Results: Fifteen adolescents (13 girls and two boys) were interviewed. We have reached total data saturation. The analysis found two meta-themes, each with two separate themes. (I) Reactions to the proposal of antidepressant with (i) an opposition phase (about the existence of depressive symptoms and about negative preconceptions) and (ii) need to share with family and other teenagers. (II) Reactions to antidepressant use with (iii) ambivalence and an initial perception of coercion, and (iv) effects of antidepressants (psychological effects, effects on the body and on anorexia nervosa and effects perceived through the eyes of others). Discussion: Despite positive effects, ambivalence toward the treatment remained present throughout the interviews: these adolescents still worry greatly about loss of control and weight gain. Depression as comorbidity seems to be entangled in the denial of disease, cognitive distortion and acquired fearlessness specific to AN. Its existence in adolescence can uncover transgenerational issues, sometimes previously hidden. An orodispersible/drinkable form of antidepressants would facilitate adherence to treatment in this specific population. The intervention of a "patient-expert" could reduce adolescents' anxiety about loss of control. A latency period seems necessary to allow them to understand the prescription at their own level and in the complexity of their anorexic illness.

Disclosure of Sibling Sexual Abuse by Hospitalized Adolescent Girls: Three Case Reports.

Although sibling sexual abuse (SSA) may be the most common type of intrafamilial sexual abuse, it has not been widely studied. The lack of studies makes it very difficult for clinicians to create a comprehensive framework about this complex phenomenon, particularly in comparison with other forms of intrafamilial sexual abuse, such as father-daughter incest. SSA is still underrecognized and underdisclosed but it has the potential to be every bit as harmful as sexual abuse by a parent. The topic rarely finds its way into the more general psychiatry or social work literature. It is imperative to increase healthcare practitioners' awareness of this complex subject to improve their ability to listen to, detect, and manage the disclosures of SSA in adolescent populations. This paper presents vignettes of three 13-to-15-year-old adolescent girls who disclosed SSA during inpatient hospitalization in an adolescent psychiatric and medicine department. These cases illustrate the complexity of SSA, which has been associated with a wide spectrum of both mental and physical symptoms. Adolescent victims of SSA experience serious distress, with various and numerous psychiatric manifestations, including but not limited to depression and suicide attempts, addictive behaviors, post-traumatic stress symptoms, and eating disorders. Physical symptoms should also alert practitioners: adolescent survivors are more likely to be affected by somatic complications such as sexually transmitted diseases, chronic pain, urogenital symptoms, and nutritional disorders. We offer some recommendations to improve the detection and support of distressed adolescents disclosing SSA. Listening to them and offering a protective multidisciplinary response can limit the lasting damage and contribute to the repair process.

A qualitative exploration of what works for migrant adolescents in transcultural psychotherapy: perceptions of adolescents, their parents, and their therapists.

BACKGROUND: Migrant adolescents are at a higher risk than their native-born counterparts of psychiatric disorders, and their care is a public health issue. In France, transcultural psychotherapy is a treatment provided by a group of therapists designed to meet the specific needs of these patients when usual care appears ineffective. The objective of this study was to explore the therapeutic elements at work in transcultural psychotherapy. METHODS: We conducted a qualitative study crossing the perspectives of adolescents receiving transcultural psychotherapy, their parents, their first-line therapist (FLT), and the transcultural therapists. The families were chosen by purposive sampling. Data were collected during semi-structured individual (for FLTs) and group (families and transcultural therapists) interviews that explored the therapeutic elements involved and effective in transcultural psychotherapy. We used interpretative phenomenological analysis (IPA) to examine the data. In all, 44 participants were questioned: three adolescents (2 girls and 1 boy, all aged 18 to 21 years) and their parents (3 mothers and 1 father), three FLTs (2 child psychiatrists and 1 psychologist), and the 34 therapists participating in the three transcultural psychotherapy groups. RESULTS: The analysis uncovered three themes: (1) the perceived effectiveness of the group's functioning; (2) the recounting of the individual, family, and cultural history to allow for complexity and nuance; and (3) the personal investment by therapists, made possible by the group. CONCLUSIONS: Our results show some therapeutic elements at work in transcultural psychotherapy that enable it to meet the particular needs of some migrant adolescents that are unmet in standard therapy. Continuing to study transcultural psychotherapy and assess its effectiveness is essential for promoting and optimizing psychiatric care for migrant adolescents.

Assessment of transcultural psychotherapy to treat resistant major depressive disorder in children and adolescents from migrant families: Protocol for a randomized controlled trial using mixed method and Bayesian approaches.

OBJECTIVES: Cultural variations complicate psychiatric care, especially for migrant children. Transcultural psychotherapy (TCP) is an original psychotherapeutic technique developed to address complex situations of resistant mental disorders in the context of migration. This research will aim to assess the efficacy, the acceptability, and describe the therapeutic processes of TCP for the treatment of depression in first or second generation of migration children and adolescents. METHOD: Mixed method study using a multicenter, Bayesian randomized clinical trial with blinded evaluation of the primary outcome. Two parallel groups of 40 children or adolescents from 6 to 20 years old and their family will be included. In the experimental group, patients will attend six sessions of transcultural therapy in addition to usual care. RESULTS: The improved Clinical Global Impression scale scores at 6 months will be compared across groups. Qualitative analysis of families and therapists' interviews will allow to specify the therapeutic processes and acceptability of the therapy. CONCLUSION: The findings will encourage the development and routinization of TCP for second-line use and its adaption as a first-line technique in this population.

Qualitative assessment of transcultural psychotherapy by adolescents and their migrant families: Subjective experience and perceived effectiveness.

OBJECTIVE: Adolescent migrants present psychological disorders more frequently than the corresponding host population but their access to care and to follow-up are less effective. The French method of transcultural psychotherapy (TPT) was conceived to respond to these problems. Our objective is to assess how these adolescents and their families perceive the experience and effectiveness of TPT. METHOD: We conducted semistructured interviews with the families of adolescents seen for TPT. The data were analyzed by a qualitative thematic methodology. RESULTS: We spoke to 21 participants in 8 families. The families came to TPT with a sense that the teen's current treatment was at an impasse. During the follow-up, they noted that family communication and relationships had improved, as had their connection to their culture of origin. Besides commenting on what they perceived as limitations, families identified specific elements of TPT as therapeutic. CONCLUSION: The pronounced diversity of the group and the use of both multiperspective narration and an interpreter were specific elements driving the construction of a good therapeutic alliance, despite the initial barriers. Pursuit of the evaluation of TPT is essential to advance the psychiatric care of adolescent migrants.

Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown.

The aim of this paper was to review the literature on adolescent psychiatric disorders related to the COVID-19 pandemic and lockdown. Stressful life events, extended home confinement, brutal grief, intrafamilial violence, overuse of the Internet and social media are factors that could influence the mental health of adolescents during this period. The COVID-19 pandemic could result in increased psychiatric disorders such as Post-Traumatic Stress, Depressive, and Anxiety Disorders, as well as grief-related symptoms. Adolescents with psychiatric disorders are at risk of a break or change in their care and management; they may experience increased symptoms. The COVID-19 pandemic and lockdown may have a negative impact on the mental health of adolescents, although there is still no data on the long term impact of this crisis. Adolescents' individual, familial, and social vulnerability, as well as individual and familial coping abilities, are factors related to adolescent mental health in times of crisis. Adolescents are often vulnerable and require careful consideration by caregivers and healthcare system adaptations to allow for mental health support despite the lockdown. Research on adolescent psychiatric disorders in times of pandemics is necessary, as such a global situation could be prolonged or repeated.

Purification of Pharmaceutical Solvents by Pervaporation through Hybrid Silica Membranes.

Solvents purification mainly used in pharmaceutical field such as acetone and methyl ethyl ketone (MEK) were performed through hybrid silica membranes and from binary and multi-components mixtures. Two hybrid silica membranes-zirconia doped bis(triethoxysilyl)methane and bis(triethoxysilyl)ethane (BTESE)-were studied. Flux, permeance, and separation factor were evaluated depending on temperature, composition, and number of organic compounds in the feed. Dehydration tests of acetone were operated at 30 and 45 °C following by acetone and MEK purification at 50 °C from multi-components hydro-organic mixtures where hydrophilic compounds (water, methanol) but also hydrophobic (dichloromethane (DCM) and/or toluene) were present. Results showed that the presence of Zr nanoparticles affected flux and improved selectivity in the case of dehydration. Experiments related to acetone and MEK purification, revealed a mass transfer alteration and a decrease of performance, from 99 to 97 wt% and from 98 to 95 wt% respectively, when the number of compounds in the initial feed grown up and more precisely, in the presence of DCM and toluene thus highlighting a possible coupling effect.

On-Line NIR to Regulate Pervaporation Process: Application for Dehydration.

The regeneration of volatile organic solvents via dehydration tests, from 90 wt %, was evaluated by pervaporation using an on-line near-infrared (NIR) spectrometer. Experiments were performed using a bis(triethoxysilyl)methane (BTESM)-based ceramic HybSi® membrane at temperatures of 20, 30 and 40 °C. The presence of an on-line NIR allows continuous monitoring of the process without sampling, and quickly estimates mass fractions of species in the retentate. Dehydration tests were performed at 30 °C in order to confirm the on-line NIR reproducibility, and closely matched results obtained with an off-line densimeter. These results validated the usefulness of the on-line NIR and provided the same precision whatever the mass fraction in the retentate. A good on-line reproducibility was found, with an agreement between the on-line NIR and off-line densimeter, obtaining an average deviation of ±0.058 wt %, ±0.17 wt % and ±0.049 wt %, respectively, at 20, 30 and 40 °C.

Treatment of radioactive liquid effluents by reverse osmosis membranes: From lab-scale to pilot-scale.

The recent use of the reverse osmosis (RO) process at the damaged Fukushima-Daiichi nuclear power plant generated a growing interest in the application of this process for decontamination purposes. This study focused on the development of a robust RO process for decontamination of two kinds of liquid effluents: a contaminated groundwater after a nuclear disaster and a contaminated seawater during a nuclear accident. The SW30 HR membrane was selected among other in this study due to higher retentions (96% for Cs and 98% for Sr) in a true groundwater. Significant fouling and scaling phenomenon, attributed to calcium and strontium precipitation, were evidenced in this work: this underscored the importance of the lab scale experiment in the process. Validation of the separation performances on trace radionuclides concentration was performed with similar retention around 96% between surrogates Cs (inactive) and 137Cs (radioactive). The scale up to a 2.6 m2 spiral wound membrane led to equivalent retentions (around 96% for Cs and 99% for Sr) but lower flux values: this underlined that the hydrodynamic parameters (flowrate/cross-flow velocity) should be optimized. This methodology was also applied on the reconstituted seawater effluent: retentions were slightly lower than for the groundwater and the same hydrodynamic effects were observed on the pilot scale. Then, ageing of the membrane through irradiation experiments were performed. Results showed that the membrane active layer composition influenced the membrane resistance towards γ irradiation: the SW30 HR membrane performances (retention and permeability) were better than the Osmonics SE at 1 MGy. Finally, to supplement the scale up approach, the irradiation of a spiral wound membrane revealed a limited effect on the permeability and retention. This indicated that irradiation conditions need to be controlled for a further development of the process.

Computational fluid dynamics simulations of membrane filtration process adapted for water treatment of aerated sewage lagoons.

The aim of this study is to apply the membrane bioreactor technology in an oxidation ditch in submerged conditions. This new wastewater filtration process will benefit rural areas (<5,000 population equivalent) subject to chronic water shortages by reusing this water for irrigation of green areas. For this purpose, the membranes developed without support are immersed in an aeration well and work in suction mode. The development of the membrane without support and more precisely the performance of spacers are approached by computational fluid dynamics in order to provide the best compromise between pressure drop/flow velocity and permeate flux. The numerical results on the layout and the membrane modules' geometry in the aeration well indicate that the optimal configuration is to install the membranes horizontally on three levels. Membranes should be connected to each other to a manifold providing a total membrane area of 18 m². Loss rate compared to the theoretical throughput is relatively low (less than 3%). Preliminary data obtained by modeling the lagoon provide access to its hydrodynamics, revealing that recirculation zones can be optimized by making changes in the operating conditions. The experimental validation of these results and taking into account the aeration in the numerical models are underway.

Volatile Organic Compound (VOC) Removal by Vapor Permeation at Low VOC Concentrations: Laboratory Scale Results and Modeling for Scale Up.

Petroleum transformation industries have applied membrane processes for solvent and hydrocarbon recovery as an economic alternative to reduce their emissions and reuse evaporated components. Separation of the volatile organic compounds (VOCs) (toluene-propylene-butadiene) from air was performed using a poly dimethyl siloxane (PDMS)/α-alumina membrane. The experimental set-up followed the constant pressure/variable flow set-up and was operated at ~21 °C. The membrane is held in a stainless steel module and has a separation area of 55 × 10-4 m². Feed stream was set to atmospheric pressure and permeate side to vacuum between 3 and 5 mbar. To determine the performance of the module, the removed fraction of VOC was analyzed by Gas Chromatography/Flame Ionization Detector (GC/FID). The separation of the binary, ternary and quaternary hydrocarbon mixtures from air was performed at different flow rates and more especially at low concentrations. The permeate flux, permeance, enrichment factor, separation efficiency and the recovery extent of the membrane were determined as a function of these operating conditions. The permeability coefficients and the permeate flux through the composite PDMS-alumina membrane follow the order given by the Hildebrand parameter: toluene > 1,3-butadiene > propylene. The simulated data for the binary VOC/air mixtures showed fairly good agreement with the experimental results in the case of 1,3-butadiene and propylene. The discrepancies observed for toluene permeation could be minimized by taking into account the effects of the porous support and an influence of the concentration polarization. Finally, the installation of a 0.02 m2 membrane module would reduce 95% of the VOC content introduced at real concentration conditions used in the oil industry.