Gender differences in psychosocial function and self-reported health status in late-diagnosed autistic adults: results from the FACE-ASD national cohort.

BACKGROUND: While adult outcome in autism spectrum disorder (ASD) is generally measured using socially valued roles, it could also be understood in terms of aspects related to health status - an approach that could inform on potential gender differences. METHODS: We investigated gender differences in two aspects of outcome related to health-status, i.e. general functioning and self-perceived health status, and co-occurring health conditions in a large multi-center sample of autistic adults. Three hundred and eighty-three participants were consecutively recruited from the FondaMental Advanced Centers of Expertise for ASD cohort (a French network of seven expert centers) between 2013 and 2020. Evaluation included a medical interview, standardized scales for autism diagnosis, clinical and functional outcomes, self-perceived health status and verbal ability. Psychosocial function was measured using the Global Assessment of Functioning scale. RESULTS: While autistic women in this study were more likely than men to have socially valued roles, female gender was associated with poorer physical and mental health (e.g. a 7-fold risk for having three or more co-occurring physical health conditions) and a poorer self-perceived health status. Psychosocial function was negatively associated with depression and impairment in social communication. Half of the sample had multiple co-occurring health conditions but more than 70% reported that their visit at the Expert Center was their first contact with mental health services. CONCLUSIONS: To improve objective and subjective aspects of health outcome, gender differences and a wide range of co-occurring health conditions should be taken into account when designing healthcare provision for autistic adults.

[Towards a pragmatic cohabitation of theoretical and clinical models: The example of "Good Psychiatric Management" in the treatment of borderline personality disorder]. / Pour une cohabitation pragmatique des modèles théoriques et cliniques : l'exemple du « Good Psychiatric Management ¼ dans le traitement du trouble de personnalité borderline.

Borderline personality disorder (BPD) is a common disorder in general and clinical populations and is related to potentially severe medical and socio-professional consequences. Treatment of BPD is based on evidence-based psychotherapies (such as Dialectical Behavioral Therapy, Mentalization-Based Therapy, Schema-Focused Therapy or Transference Focused Psychotherapy), which have been shown effective but are poorly available in France. Pharmacological treatments, which are more easily available, are not effective in treating symptoms of the disorder but can be useful in management of comorbidities. In this context, recently called "generalist" models have been developed, which every well-trained psychiatrist can implement in their daily practice, combining practical elements from evidence-based psychotherapies and elements of pharmacological management of symptoms and comorbidities. The purpose of this article is to present one of these models, the Good Psychiatric Management (GPM) and its basic principles and its applications, and to provide one of the first French-speaking resources about this model. In addition, beyond the practical elements proposed by the GPM, we discuss the deeper question that it raises, namely the question of a pragmatic integration of different theoretical and clinical models. Indeed, the treatment of BPD patients is at the junction of different conceptualizations of mental pathology (psychopathological, neurobiological) and different modalities of practice (psychotherapy, biological psychiatry). In a French context, that sometimes separates these two models, and in our opinion GPM constitutes an example of clinical collaboration which shows the interest of the combined role of psychiatrist-psychotherapist.

Borderline personality disorder and adolescent suicide attempt: the mediating role of emotional dysregulation.

BACKGROUND: Emotional dysregulation seems to be a core feature of Borderline Personality Disorders (BPD). In addition, recent research in the adolescent population has shown that suicidal behaviours have been associated with maladaptive strategies of emotion regulation. METHODS: This study examined the relative contributions of emotional dysregulation to suicide attempt history in a clinical sample of borderline adolescents. Data were analyzed from 85 participants of the Collaborative European Research Network on Borderline Personality Disorder. Participants completed measures of BPD traits and symptoms, suicide behaviours, emotional dysregulation, attachment styles and lifetime depressive disorders. RESULTS: In an SEM model, lifetime depressive disorders and insecure attachment styles have a significant direct effect on lifetime suicide attempt, but only lifetime depressive disorders have an indirect effect through emotion dysregulation. The results suggest that emotional dysregulation has a mediating role in suicide attempts among BPD adolescents. CONCLUSIONS: These findings call for the development of interventions targeting the role of emotion dysregulation in effectively predicting and preventing suicidality in borderline adolescents.

Evaluating the effectiveness of a single-day simulation-based program in psychiatry for medical students: a controlled study.

BACKGROUND: Training in psychiatry requires specific knowledge, attitudes, and skills that are obtainable by simulation, of which the use is only recent and still needs further development. Evidence is accumulating on its effectiveness but requires further validation for medical students. We aimed to evaluate the effectiveness of a single-day optional teaching program in psychiatry by simulation for medical students and validate a scale measuring Confidence in Psychiatric Clinical Skills (CPCQ), as part of the assessment. METHODS: This was a controlled study in a French University that compared (using paired-sample Student t-tests) knowledge and attitudes (university grades and CPCQ scores) before, just after teaching with simulated patients, and 2 months later. Satisfaction with the program (including the quality of the debriefing) was also investigated. The CPCQ scale was validated by assessing the factor structure, internal consistency, and test-retest reliability. Finally, a comparison was run with a control group who received the usual psychiatric instruction using covariance analyses. RESULTS: Twenty-four medical students were included in the simulation group and 76 in the control group. Just after the simulation, knowledge and attitudes increased significantly in the simulation group. Satisfaction with the training and debriefing was very high. The CPCQ scale showed good psychometric properties: a single-factor structure, acceptable internal consistency (α = 0.73 [0.65-0.85]), and good test-retest reliability (ICC = 0.71 [0.35-0.88]). Two months after the simulation, knowledge and attitudes were significantly higher in the simulation group than the control group, despite a lack of difference in knowledge before the simulation. CONCLUSIONS: Adding a simulation program in psychiatry to the usual teaching improved the knowledge and confidence of medical students. The CPCQ scale could be used for the evaluation of educational programs.

Validation of the French version of the McLean screening instrument for borderline personality disorder (MSI-BPD) in an adolescent sample.

BACKGROUND: The study examines the psychometric properties of the French version of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) created by M. Zanarini to screen borderline personality disorder in clinical and non-clinical populations. METHOD: In this multicentric longitudinal study from the European Network on Borderline Personality Disorder, a sample of 84 adolescent patients from five psychiatric centres and 85 matched controls without psychiatric comorbidity completed the MSI-BPD, French version, and were interviewed with the Structured Interview for DSM-IV Personality (SIDP-IV), in order to assess the presence or absence of borderline personality disorder. RESULTS: The MSI-BPD showed excellent internal consistency (α = 0.87 [0.84;0.90]). Compared to the semi-structured reference interview (SIDP-IV), the MSI-BPD showed substantial congruent validity (AUC = 0.93, CI 95%: 0.90-0.97). The optimal cut-off point in the present study was 5 or more, as it had relatively high sensitivity (0.87) and specificity (0.85). In our sample, the cut-off point (7 or more) proposed by the original developers of the MSI-BPD showed high specificity (0.95) but low sensitivity (0.63). CONCLUSIONS: The French version of the MSI-BPD is now available, and its psychometric properties are satisfactory. The French version of the MSI-PBD can be used as a screening tool for borderline personality disorder, for clinical purposes or in research studies.

Roles of age, gender and psychological difficulties in adolescent mentalizing.

INTRODUCTION: Adolescence is a critical period for the development of mentalizing - the imaginative capacity to understand one's own and others' behaviour in terms of underlying mental states. Yet, factors and mechanisms underlying individual differences in adolescent mentalizing remain poorly understood. This exploratory study examined whether and how a) age and gender and b) psychological difficulties correlate with mentalizing performance in adolescents from the general population. METHODS: 89 adolescents from Geneva, Switzerland (54 females, age 12-17 years) completed a computerized task of mentalizing and a self-report measure of psychopathology. RESULTS: Mentalizing performance improved with age. Males showed lower scores on the mentalizing task and made more hypermentalizing errors than females. The main findings revealed a negative association between mentalizing performance and self-reported attention problems. Post-hoc analyses further demonstrated that self-reported attentional difficulties were particularly associated with weaker scores on items requiring mentalizing about intentions, while self-reported withdrawal/depression symptoms were particularly associated with weaker scores on items requiring mentalizing about emotions and thoughts. CONCLUSION: The present study highlights a negative association between attentional difficulties and mentalizing performance in community adolescents. Moreover, it provides preliminary evidence suggesting that age, gender and psychological difficulties can be distinctively associated with patterns of correct and incorrect mentalizing in community adolescents. Implications for future research and clinical practice are discussed.

Telepsychiatry for Children and Adolescents: A Review of the PROMETTED Project.

BACKGROUND: Telemedicine for children and adolescents is a public health topic, and since 2009 in France, the legal framework defines practical modalities. Some children with Attention Deficit with or without Hyperactivity Disorder, social anxiety, or Autism Spectrum Disorder (ASD) can be easily engaged within a teleconsultation model. Literature suggests new opportunities to facilitate the care process for the ASD person and his family: diagnosis with the use of validated instruments and parental accompaniment. METHODS: Since 2015, a pilot project called PROMETTED was supported by the Regional Health Agency of Ile de France. It was developed and managed by the team of the Center for Diagnosis and Evaluation for Autism (CDEA) of Sainte-Anne Hospital and associated PEDIATED, the CDEA of Versailles. RESULTS: Five medico-social structures for children and adolescents with ASD and the two CDEAs co-elaborated a scheme of intervention with telemedicine. The remote evaluation is a four-step process structured around the medical history and the observation of the young subject; the Autism Diagnostic Interview; the use of the Childhood Autism Rating Scale and the Vineland Adaptive Behavior Scales; and feedback to parents. CONCLUSIONS: Medico-economic and satisfaction evaluations are in progress.

ESCAP Expert Article: borderline personality disorder in adolescence: an expert research review with implications for clinical practice.

Borderline personality disorder (BPD) has onset in adolescence, but is typically first diagnosed in young adulthood. This paper provides a narrative review of the current evidence on diagnosis, comorbidity, phenomenology and treatment of BPD in adolescence. Instruments available for diagnosis are reviewed and their strengths and limitations discussed. Having confirmed the robustness of the diagnosis and the potential for its reliable clinical assessment, we then explore current understandings of the mechanisms of the disorder and focus on neurobiological underpinnings and research on psychological mechanisms. Findings are accumulating to suggest that adolescent BPD has an underpinning biology that is similar in some ways to adult BPD but differs in some critical features. Evidence for interventions focuses on psychological therapies. Several encouraging research studies suggest that early effective treatment is possible. Treatment development has just begun, and while adolescent-specific interventions are still in the process of evolution, most existing therapies represent adaptations of adult models to this developmental phase. There is also a significant opportunity for prevention, albeit there are few data to date to support such initiatives. This review emphasizes that there can be no justification for failing to make an early diagnosis of this enduring and pervasive problem.

[Not Available].

The aim of this paper is to discuss the psychological factors involved in the process of learning and especially to conceptualize the impact of cognitive disorders on the emotional.

Specifying the timescale of early life unpredictability helps explain the development of internalising and externalising behaviours.

Early life unpredictability is associated with both physical and mental health outcomes throughout the life course. Here, we classified adverse experiences based on the timescale on which they are likely to introduce variability in children's environments: variations unfolding over short time scales (e.g., hours, days, weeks) and labelled Stochasticity vs variations unfolding over longer time scales (e.g., months, years) and labelled Volatility and explored how they contribute to the development of problem behaviours. Results indicate that externalising behaviours at age 9 and 15 and internalising behaviours at age 15 were better accounted for by models that separated Stochasticity and Volatility measured at ages 3 to 5. Both externalising and internalising behaviours were specifically associated with Volatility, with larger effects for externalising behaviours. These findings are interpreted in light of evolutionary-developmental models of psychopathology and reinforcement learning models of learning under uncertainty.

Corrigendum: Paradoxes in borderline emotional dysregulation in adolescence: influence of parenting, stressful life events, and attachment.

[This corrects the article DOI: 10.3389/fpsyt.2021.735615.].

The lived experience of French parents concerning the diagnosis of their children with borderline personality disorder.

BACKGROUND: Psychiatrists often hesitate to diagnose borderline personality disorder (BPD). While individuals with BPD have reported both positive and negative experiences upon receiving their diagnosis, no study has specifically explored this issue among parents. Parents of children diagnosed with BPD can benefit from recently developed family-support interventions such as the Family Connections program. Our study aimed to explore the experiences of parents learning about their child's BPD diagnosis and to investigate the impact of the Family Connections program on their experiences. METHODS: This qualitative study, conducted in France following the five-stage IPSE method, involved parents of children with BPD recruited through the Family Connections association in Versailles. We conducted semi-structured interviews and used purposive sampling for data collection until data saturation was reached. Data analysis was performed using a descriptive and structuring approach with NVivo 12 software to elucidate the structure of lived experiences. RESULTS: The study included 21 parents. The structure of the lived experiences was characterized by three central axes: (1) the long and difficult road to diagnosis; (2) communicating the BPD diagnosis to parents: a necessary step; (3) the pitfalls of receiving the diagnosis. The Family Connections program provided significant support in these areas, particularly in understanding the diagnosis, enhancing communication with their child, and reducing social isolation. CONCLUSION: These findings highlight the challenges parents face when receiving a BPD diagnosis for their child and underscore the need for an early, clear, and detailed explanation of the diagnosis. The specific experiences of receiving the diagnosis are indicative of the broader care experience parents undergo and highlight their need and right to be informed, supported, and guided throughout their child's treatment.

Proposition of a transdiagnostic processual approach of emotion dysregulation based on core triggers and interpersonal styles.

Emotion dysregulation (ED) has primarily been described in patients suffering from borderline personality disorder (BPD) and is an integral part of this diagnosis, but it is also a transdiagnostic construct that can be found in several other psychiatric disorders. The strong relationships between ED and BPD may lead clinicians to underestimate ED associated to other clinical contexts. This can lead to difficulties in diagnostic and treatment orientation, especially in the context of comorbidities. In this article, after reviewing the literature on the development and functioning of emotion dysregulation, and on the evidence for emotion dysregulation in eight disorders (borderline personality disorder, pathological narcissism with/without narcissistic personality disorder, obsessive-compulsive personality disorder, antisocial personality disorder, bipolar disorder, autism spectrum disorder, complex post-traumatic stress disorder, and adult attention deficit hyperactivity disorder), we present a transdiagnostic processual model of emotion dysregulation based on core triggers and interpersonal styles to try to address this issue and to provide a simple but technical tool to help clinicians in their diagnostic assessment and treatment orientation. By focusing more on typical patterns and interpersonal dynamics than only on categories, we believe that this model may contribute to the actual need for improvement of our current psychiatric classifications, alongside other well-studied and under-used dimensional models of psychopathology (e.g., HiTOP, AMPD), and may be useful to build more specific treatment frameworks for patients suffering from ED.

Cardiovascular Complications in Patients with Heart Failure and COVID-19: CARDIO COVID 19-20 Registry.

Since early 2020, different studies have shown an increased prevalence of COVID-19 and poorer prognosis in older adults with cardiovascular comorbidities. This study aimed to assess the impact of heart failure (HF) on cardiovascular complications, intensive care unit (ICU) admissions, and in-hospital mortality in patients hospitalized with COVID-19. The CARDIO COVID 19-20 registry includes 3260 hospitalized patients with a COVID-19 serological diagnosis between May 2020 and June 2021 from Latin American countries. A history of HF was identified in 182 patients (5.6%). In patients with and without previous HF, the incidence of supraventricular arrhythmia was 16.5% vs. 6.3%, respectively (p = 0.001), and that of acute coronary syndrome was 7.1% vs. 2.7%, respectively (p = 0.001). Patients with a history of HF had higher rates of ICU admission (61.5% vs. 53.1%, respectively; p = 0.031) and in-hospital mortality (41.8% vs. 24.5%, respectively; p = 0.001) than patients without HF. Cardiovascular mortality at discharge (42.1% vs. 18.5%, respectively; p < 0.001) and at 30 days post-discharge (66.7% vs. 18.0%, respectively) was higher for patients with a history of HF than for patients without HF. In patients hospitalized with COVID-19, previous history of HF was associated with a more severe cardiovascular profile, with increased risk of cardiovascular complications, and poor in-hospital and 30-day outcomes.

American Registry of Ambulatory or acutely decompensated heart failure (AMERICCAASS Registry): First 1000 patients.

BACKGROUND: About 80% of cardiovascular diseases (including heart failure [HF]) occur in low-income and developing countries. However, most clinical trials are conducted in developed countries. HYPOTHESIS: The American Registry of Ambulatory or Acutely Decompensated Heart Failure (AMERICCAASS) aims to describe the sociodemographic characteristics of HF, comorbidities, clinical presentation, and pharmacological management of patients with ambulatory or acutely decompensated HF in America. METHODOLOGY: Descriptive, observational, prospective, and multicenter registry, which includes patients >18 years with HF in an outpatient or hospital setting. Collected information is stored in the REDCap electronic platform. Quantitative variables are defined according to the normality of the variable using the Shapiro-Wilk test. RESULTS: This analysis includes data from the first 1000 patients recruited. 63.5% were men, the median age of 66 years (interquartile range 56.7-75.4), and 77.6% of the patients were older than 55 years old. The percentage of use of the four pharmacological pillars at the time of recruitment was 70.7% for beta-blockers (BB), 77.4% for angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB II)/angiotensin receptor-neprilysin inhibitor (ARNI), 56.8% for mineralocorticoid receptor antagonists (MRA), and 30.7% for sodium-glucose cotransporter type-2 inhibitors (SGLT2i). The main cause of decompensation in hospitalized patients was HF progression (64.4%), and the predominant hemodynamic profile was wet-warm (68.3%). CONCLUSIONS: AMERICCAASS is the first continental registry to include hospitalized or outpatient patients with HF. Regarding optimal medical therapy, approximately a quarter of the patients still need to receive BB and ACEI/ARB/ARNI, less than half do not receive MRA, and more than two-thirds do not receive SGLT2i.

Attention-deficit/hyperactivity disorder and impairment in executive functions: a barrier to weight loss in individuals with obesity?

BACKGROUND: An increasing body of research points to a significant association of obesity to Attention-Deficit/Hyperactivity Disorder (ADHD) and deficits in executive functions. There is also preliminary evidence suggesting that children with ADHD may be at risk of obesity in adulthood. DISCUSSION: In this article, we discuss the evidence showing that ADHD and/or deficits in executive functions are a barrier to a successful weight control in individuals enrolled in weight loss programs. Impairing symptoms of ADHD or deficits in executive functions may foster dysregulated eating behaviors, such as binge eating, emotionally-induced eating or eating in the absence of hunger, which, in turn, may contribute to unsuccessful weight loss. ADHD-related behaviors or neurocognitive impairment may also hamper a regular and structured physical activity. There is initial research showing that treatment of comorbid ADHD and executive functions training significantly improve the outcome of obesity in individuals with comorbid ADHD or impairment in executive functions. SUMMARY: Preliminary evidence suggests that comorbid ADHD and deficits in executive functions are a barrier to a successful weight loss in individuals involved in obesity treatment programs. If further methodologically sound evidence confirms this relationship, screening and effectively managing comorbid ADHD and/or executive functions deficits in individuals with obesity might have the potential to reduce not only the burden of ADHD but also the obesity epidemics.

Depressive symptoms among teenagers in the emergency department: prevalence estimate and concordance with parental perceptions.

PURPOSE: This study aims to estimate the prevalence of depressive symptoms among adolescents seen in hospital emergency departments and to investigate the concordance between self-reported adolescent depression and parental perceptions of their adolescents' health status. METHOD: A multicentre cross-sectional survey in three emergency departments receiving adolescents in Ile-de-France took place in 2010. All adolescents completed a questionnaire including the Adolescent Depression Rating Scale (ADRS) and a series of questions concerning somatisation and risk behaviours. Parents simultaneously completed a questionnaire collecting their perceptions of their adolescent's health status. RESULTS: The study included 346 adolescents, and of them, 320 were fully analysed. ADRS scores were in the normal range for 70.6 % of the sample (score of <3) (n=226); 19.4 % (n=62) showed moderate depressive symptoms (3 ≤ score<6), and 10.0 %, severe depressive symptoms (score of ≥ 6) (n=32). We observed a wide discrepancy between adolescent depression, determined by a score on a self-administered scale, and parental perceptions of it. CONCLUSION: Routine use of a self-administered questionnaire in emergency units could enable identification of adolescents with moderate or severe depressive symptoms. The present study confirms the importance of increasing parental awareness of their adolescent children's depressive symptoms.

Axis II comorbidity of borderline personality disorder in adolescents.

AIMS: The objective of the present study was to explore the comorbidity of borderline personality disorder (BPD) with other personality disorders in adolescents and compare these comorbidities in male and female subjects. METHODS: The sample was drawn from a European research project investigating the phenomenology of BPD in adolescence (EURNET BPD). A total of 85 BPD patients (11 boys and 74 girls) with a mean age of 16.3 years were included in the study. RESULTS: According to the results of the Structured Interview for DSM-IV Disorders of Personality, obsessive-compulsive (35.3%), antisocial (22.4%), avoidant (21.2%), dependent (11.8%) and paranoid (9.4%) personality disorders had significant co-occurrences with BPD. Although none of the gender differences was statistically significant, we observed a trend towards higher rates of antisocial personality disorders in men (45.5%) than in women (19%). CONCLUSION: The study results confirmed the frequency of Axis II comorbidity in adolescents with BPD and, for the first time, evidenced a differential pattern of comorbidity in males and females. This differential pattern must be taken into account when developing treatment strategies for adolescents with BPD.

Observational Cohort Study Dedicated to Autism Spectrum Disorder: Milestone Steps, Results Updates, Perspectives.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by persistent difficulties in two domains: social communication and interaction, alongside with restricted, repetitive pattern of behaviors. It affects children and persists into adolescence and adulthood. Its causes and underlying psychopathological mechanisms are unknown and remain to be discovered. TEDIS cohort study developed over the decade 2010-2022, in Ile-de-France region, includes 1300 patients' files up to date, with valuable health information drawn from ASD evaluation. It provides researchers and decision makers with reliable data source to improve knowledge and practice in the context of ASD patients.