Chronic illness, life style and emotional health in adolescence: results of a cross-sectional survey on the health of 15-20-year-olds in Switzerland.

The objective was to evaluate the prevalence of chronic conditions (CC) in adolescents in Switzerland; to describe their behaviour (leisure, sexuality, risk taking behaviour) and to compare them to those in adolescents who do not have CC in order to evaluate the impact of those conditions on their well-being. The data were obtained from the Swiss Multicentre Adolescent Survey on Health, targeting a sample of 9268 in-school adolescents aged 15 to 20 years, who answered a self-administered questionnaire. Some 11.4% of girls and 9.6% of boys declared themselves carriers of a CC. Of girls suffering from a CC, 25% (versus 13% of non carriers; P=0.007) and 38% of boys (versus 25%; P=0.002) proclaimed not to wear a seatbelt whilst driving. Of CC girls, 6.3% (versus 2.7%; P=0.000) reported within the last 12 months to have driven whilst drunk. Of the girls, 43% (versus 36%; P=0.004) and 47% (versus 39%; P=0.001) were cigarette smokers. Over 32% of boys (versus 27%; P=0.02) reported having ever used cannabis and 17% of girls (versus 13%; P=0.013) and 43% of boys (versus 36%; P=0.002) admitted drinking alcohol. The burden of their illness had important psychological consequences: 7.7% of girls (versus 3.4%; P=0.000) and 4.9% of boys (versus 2.0%; P=0.000) had attempted suicide during the previous 12 months. CONCLUSION: experimental behaviours are not rarer in adolescents with a chronic condition and might be explained by a need to test their limits both in terms of consumption and behaviour. Prevention and specific attention from the health caring team is necessary.

Early change in maladaptive defense style and development of the therapeutic alliance

Résumé Cette étude examine les changements précoces dans le Style Défensif Maladaptatif (SDM), le développement de l'alliance thérapeutique et la relation entre le SDM et l'alliance au cours d'une psychothérapie psychodynamique ultra-brève. Soixante-huit patients ambulatoires du centre de consultation psychiatrique et psychothérapique ont bénéficié d'une intervention psychodynamique en quatre séances. Les mesures des défenses et de l'alliance étaient effectuées à la première et à la dernière séance. Les patients qui ont débuté l'intervention avec une alliance faible et qui l'ont terminée avec une alliance haute (groupe de patients avec une alliance de croissance linéaire) ont diminué leur utilisation de défenses maladaptatives de manière significative au cours de la thérapie, alors que ce n'a pas été le cas pour les patients des groupes à alliances haute-stable et basse-stable. Les résultats ont montré qu'à la fin de l'intervention, le SDM et l'alliance étaient corrélés pour tous les patients. Cette corrélation intéressait plus particulièrement le groupe avec une alliance de croissance linéaire. Ces résultats suggèrent, que le développement de l'alliance thérapeutique reflètent le travail de collaboration entre le patient et son thérapeute alors qu'ils essayent de mieux comprendre les causes de la crise du patient. Cette compréhension peut aider à réduire les défenses initialement activées pour permettre au patient de se défendre de l'anxiété et d'un sentiment de détresse. Abstract This study examined the early change in Maladaptive Defense Style (MDS), the development of the Therapeutic Alliance, and the relationship between MDS and alliance, in a short psychodynamic intervention. Sixty-eight outpatients from a psychiatric clinic completed a four-session psychodynamic intervention. Defense and alliance measures were collected at the intake and the final session. Patients who began the intervention with a poor alliance but ended with a good alliance (linear growth therapeutic alliance group) significantly decreased their use of maladaptive defenses over the course of therapy, while patients in the high and low alliance groups did not. Results showed that at the end of the intervention, MDS and alliance were related across all patients. This relation concerned particularly the linear growth therapeutic alliance profile. These results suggest that the developing therapeutic alliance might reflect the collaborative work between the patient and the therapist as they try to understand the causes of the crisis. This understanding might help reduce maladaptive defenses that were initially activated to ward off anxiety and distress.

Sirolimus-induced acneiform eruption.

Sirolimus is a new immunosuppressive agent used to prevent rejection in renal allograft recipients in order to reduce the need of potentially nephrotoxic calcineurin inhibitors (cyclosporine, tacrolimus). The cutaneous side effects of sirolimus are not well known and they may have been underestimated. We report 2 cases of follicular acneiform eruptions induced by sirolimus in renal allograft recipients. This dermatologic complication was severe and difficult to treat, and resolved only after discontinuation of sirolimus.