Pédiatrie. (2.) Consultation de médecine du sport dédiée à l'adolescent [Sport medicine consultation for adolescents].

Sport activity is a determinant of health and well-being for adolescents' psychological and physic development. Early detection of traumatic lesions or pathological condition among sportive adolescent in the light of their developmental stage is of outmost importance and is best done by an interdisciplinary team. This clinical management also aims at preventing consequences of inappropriate training. The CHUV has set-up a specific sports medicine outpatient consultation clinic for adolescents in the order to provide the best integrative management of young athletes.

The difference of disease perception by juvenile idiopathic arthritis patients and their parents : analysis of the JAMAR questionnaire.

BACKGROUND: The JAMAR (Juvenile Arthritis Multidimensional Assessment Report) has been developed to evaluate the perception of the patient and his parents on different items: well-being, pain, functional status, quality of life, disease activity, disease course, side effects of medication, therapeutic compliance and satisfaction with illness outcome. Our aim was to compare disease's perception by JIA patients and their parents. METHODS: We included into the study 100 consecutive patients over 7 years of age. We asked both parent and child to complete the JAMAR questionnaire. For each patient we recorded demographic and disease related data. We examined the level of disagreement between children and parents for the quantitative items of the JAMAR: VAS Pain, VAS Disease Activity, VAS Well Being, Juvenile Arthritis Functional Score, HRQoL. Then we looked for a relation between discordance-rate and demographic and clinical variables. RESULTS: Children and parents' median scores for all five items were similar. Individual dyads agreement was low, with a large amount of pairs (80) discordant for at least one item. We found higher MD VAS and JADAS in more discordant dyads, suggesting that when the disease is more active discordance between child and parent increase. CONCLUSION: The JAMAR questionnaire is an important tool that helps clinicians to detect divergent child and parent's disease perceptions. It is essential that both patients and parents fill the JAMAR questionnaire for a complete clinical and psychosocial evaluation.

Sexualité et destin du sexuel dans les violences sexuelles à l'adolescence : un avatar du processus adolescent

Le thème des adolescents abuseurs sexuels est ici abordé sous un angle à la fois anthropologique, historique, clinique, juridique, à l'initiative du Centre de ressources sur les auteurs de violences sexuelles (CRIAVS Centre). Dans les médias ainsi que dans les consultations, les adolescents auteurs de violence sexuelle sont de en plus nombreux. Ils viennent interroger les soignants dans leur clinique et leur pratique, à l'instar de la société qui a bien du mal à contenir l'émotion suscitée et à réagir au mieux en évitant la banalisation ou la précipitation. Cet ouvrage apporte des réponses sans simplification ni dogmatisme.

Le Rorschach en clinique de l'enfant et de l'adolescent - Approche psychanalytique (2ème édition)

L'ouvrage propose, dans une perspective psychanalytique, une approche didactique de la pratique de l'épreuve de Rorschach auprès des enfants et des adolescents, dans la spécificité de l'engagement que cette pratique requiert, en mettant successivement l'accent sur : la place et les enjeux de la passation de l'épreuve dans le contexte de la consultation en psychologie clinique et en psychopathologie (en lien avec la pratique d'autres épreuves) ; les aspects méthodologiques qui président à la passation de l'épreuve et à la cotation des réponses ; le repérage et l'identification des problématiques qui concourent à l'interprétation de l'épreuve ; la mise en perspective des productions projectives en fonction de l'âge de l'enfant ou de l'adolescent ; la présentation et l'analyse de situations de consultation dans le champ de la clinique et de la psychopathologie de l'enfant et de l'adolescent. L'ensemble est largement illustré d'exemples de réponses et de protocoles d'enfants ou d'adolescents. Public : Inscrit dans la pratique clinique, cet ouvrage est un outil indispensable pour les psychologues désireux d'approfondir la pratique de l'épreuve de Rorschach et pour les étudiants en psychologie clinique et en psychopathologie soucieux de s'y former.

Parent-adolescent relationship in youths with a chronic condition.

BACKGROUND: Suffering from a chronic disease or disability (CDD) during adolescence can be a burden for both the adolescents and their parents. The aim of the present study is to assess how living with a CDD during adolescence, the quality of parent-adolescent relationship (PAR) and the adolescent's psychosocial development interact with each other. METHODS: Using the Swiss Multicenter Adolescent Survey on Health 2002 (SMASH02) database, we compared adolescents aged 16-20 years with a CDD (n = 760) with their healthy peers (n = 6493) on sociodemographics, adolescents' general and psychosocial health, interparental relationship and PAR. RESULTS: Bivariate analyses showed that adolescents with a CDD had a poorer psychosocial health and a more difficult relationship with their parents. The log-linear model indirectly linked CDD and poor PAR through four variables: two of the adolescents' psychosocial health variables (suicide attempt and sensation seeking), the need for help regarding difficulties with parents and a highly educated mother that acted as a protective factor, allowing for a better parent-adolescent with a CDD relationship. CONCLUSION: It is essential for health professionals taking care of adolescents with a CDD to distinguish between issues in relation with the CDD from other psychosocial difficulties, in order to help these adolescents and their parents deal with them appropriately and thus maintain a healthy PAR.

Consultation for Disordered Puberty: What Do Adolescent Medicine Patients Teach Us?

The period of adolescence is not only marked by important growth and pubertal events, but is also characterized by important psychosocial changes driven by a search for autonomy and the construction of one's identity. It can thus be easily understood that puberty disorders interfere heavily with these process, requiring from the endocrinologist not only medical knowledge, but also a great deal of emotional and psychological skills. They must progressively move from an educational approach that heavily involves the parents to one of shared information and decision making that places the young patient at the center of the therapeutic process. This can be achieved in several ways: respecting the affective and cognitive development of the adolescent; securing his privacy and (if requested by him) confidentiality; exploring his self-image and self-esteem and adapting the therapeutic process to the patient's expectations; reviewing the teenager's lifestyle, including the issue of sexuality and sexual behavior, and involving him in any therapeutic choice that has to be made, even if it does not match with the parents' expectations. The skills required for this respectful and holistic follow-up often exceed the abilities of any physician; it is thus suggested that a team approach involving a clinical nurse and/or a psychologist and/or social worker(s) be set up whenever possible.

Smoking, Alcohol, Drug Use, Abuse and Dependence in Narcolepsy and Idiopathic Hypersomnia: A Case-Control Study.

STUDY OBJECTIVES: Basic experiments support the impact of hypocretin on hyperarousal and motivated state required for increasing drug craving. Our aim was to assess the frequencies of smoking, alcohol and drug use, abuse and dependence in narcolepsy type 1 (NT1, hypocretin-deficient), narcolepsy type 2 (NT2), idiopathic hypersomnia (IH) (non-hypocretin-deficient conditions), in comparison to controls. We hypothesized that NT1 patients would be less vulnerable to drug abuse and addiction compared to other hypersomniac patients and controls from general population. METHODS: We performed a cross-sectional study in French reference centres for rare hypersomnia diseases and included 450 adult patients (median age 35 years; 41.3% men) with NT1 (n = 243), NT2 (n = 116), IH (n = 91), and 710 adult controls. All participants were evaluated for alcohol consumption, smoking habits, and substance (alcohol and illicit drug) abuse and dependence diagnosis during the past year using the Mini International Neuropsychiatric Interview. RESULTS: An increased proportion of both tobacco and heavy tobacco smokers was found in NT1 compared to controls and other hypersomniacs, despite adjustments for potential confounders. We reported an increased regular and frequent alcohol drinking habit in NT1 versus controls but not compared to other hypersomniacs in adjusted models. In contrast, heavy drinkers were significantly reduced in NT1 versus controls but not compared to other hypersomniacs. The proportion of patients with excessive drug use (codeine, cocaine, and cannabis), substance dependence, or abuse was low in all subgroups, without significant differences between either hypersomnia disorder categories or compared with controls. CONCLUSIONS: We first described a low frequency of illicit drug use, dependence, or abuse in patients with central hypersomnia, whether Hcrt-deficient or not, and whether drug-free or medicated, in the same range as in controls. Conversely, heavy drinkers were rare in NT1 compared to controls but not to other hypersomniacs, without any change in alcohol dependence or abuse frequency. Although disruption of hypocretin signaling in rodents reduces drug-seeking behaviors, our results do not support that hypocretin deficiency constitutes a protective factor against the development of drug addiction in humans.