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.

Two-year follow-op of cognitive functions in Schizophrenia spectrum disorders of adolescent patients treated with electroconvulsive therapy

Objective: The aim of the current study was to investigate the long-term cognitive effects of electroconvulsive therapy (ECT) in a sample of adolescent patients in whom schizophrenia spectrum disorders were diagnosed. Methods: The sample was composed of nine adolescent subjects in whom schizophrenia or schizoaffective disorder was diagnosed according to DSM-IV-TR criteria on whom ECT was conducted (ECT group) and nine adolescent subjects matched by age, socioeconomic status, and diagnostic and Positive and Negative Syndrome Scale (PANSS) total score at baseline on whom ECT was not conducted (NECT group). Clinical and neuropsychological assessments were carried out at baseline before ECT treatment and at 2-year follow-up. Results: Significant differences were found between groups in the number of unsuccessful medication trials. No statistically significant differences were found between the ECT group and theNECT group in either severity as assessed by the PANSS, or in any cognitive variables at baseline.At follow-up, both groups showed significant improvement in clinical variables (subscales of positive, general, and total scores of PANSS and Clinical Global Impressions-Improvement). In the cognitive assessment at follow-up, significant improvement was found in both groups in the semantic category of verbal fluency task and digits forward. However, no significant differences were found between groups in any clinical or cognitive variable at follow-up. Repeated measures analysis found no significant interaction of time · group in any clinical or neuropsychological measures. Conclusions: The current study showed no significant differences in change over time in clinical or neuropsychological variables between the ECT group and the NECT group at 2-year follow-up. Thus, ECT did not show any negative influence on long-term neuropsychological variables in our sample.

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.

Estudi de prevalença de sobrepès i obesitat en la població adolescent de Girona

L’obesitat infantil, és un dels problemes de salut pública més greus del segle XXI, on la prevalença ha augmentat de manera alarmant a nivell mundial. Aquesta es defineix com una malaltia crònica i multifactorial, que sol iniciar-se en la infantesa i a l’adolescència. L’objectiu principal d’aquest estudi és conèixer la prevalença de sobrepès i obesitat en la població adolescent de Girona, i relacionar amb aquesta, els hàbits alimentaris, els hàbits d’activitat física, l’entitat de l’institut-escola, hores de son i nivell màxim d’estudis dels progenitors. Material i mètodes: Estudi descriptiu, observacional i transversal sobre una mostra de la població adolescent de Girona de 14 a 16 anys (n=185), els quals se’ls va administrar un qüestionari on es van recollir les variables relacionades amb l’estudi. L’obesitat i el sobrepès es van definir com valors de l’índex de massa corporal iguals o superiors als valors dels percentils 97 i 85, respectivament, de les taules de referencia de la OMS de 2007. Resultats: La prevalença de sobrepès i d’obesitat en la població adolescent de Girona és del 20% i del 3,78%, respectivament. El sobrepès i l’obesitat (23,78%) ha afectat més al sexe masculí (27,7%) respecte el femení (19,8%). S’ha establert relació significativa entre la prevalença de sobrepès i obesitat amb el nivell màxim d’estudis dels progenitors. Hi ha més prevalença de sobrepès i obesitat a l’institut públic en vers el privat amb un 26,7% respecte el 18,5%. Conclusions: Segons la bibliografia consultada, la població adolescent de Girona presenta més elevada la prevalença de sobrepès però no pel que fa la prevalença d’obesitat

Does visual impairment in a child or an adolescent affect their parents' quality of life? : A literature review

The purpose of this research was to determine whether the existing research shows that having a child with a visual impairment affects their parents' quality of life and, if it is thecase, in what way it does.

Aggression and its Management in Adolescent Forensic Psychiatric Care

The overall goal of this study was to explore and identify good aggression management methods and on that basis to produce recommendations for aggression management in the adolescent forensic setting. The study was conducted in three phases. In Phase I, staff’s (n = 58) perception of adolescent aggressive behaviour and methods to manage it was examined. In Phase II, staff’s (n = 30) perception of treatment settings and treatment interventions available were studied. In Phase III, the effectiveness of an aggression management programme was evaluated. The data were collected during the period 2004-2007. Participants perceived adolescent aggressive behaviour in a similar way and described aggressive behaviour as being a comprehensible phenomenon. Management methods used to control aggressive situations were alike, although the practical solutions varied between the study units, especially regarding coercive methods. Staff members proposed more time and better opportunities to discuss and evaluate the aggression situation in order to improve the methods used. The treatment settings were similar in studied forensic units and interventions were primarily focused on psychological aspects, including management of aggressive behavior. A comprehensive aggression management programme proved to be effective in decreasing incidents of violence. The use of coercive methods in aggression situations decreased and injuries to the staff became less frequent. If staff members intend to apply high quality management methods in aggression situations they have to share a consistent understanding of aggressive behaviour and need to be aware of the various methods available. In addition, they should learn more about assessment methods in order to improve aggression management. International comparison of aggression, methods for managing it and service provision creates a starting point for developing equal care provision and realization within and between European countries.

Containment Measures in Adolescent Psychiatric Care - Focus on Mechanical Restrain

Rajoitetoimet, erityisesti sitominen, nuorisopsykiatrisessa hoitotyössä Tutkimuksen tavoitteena oli kuvata ja syventää tietoa rajoitetoimien, erityisesti sitomisen, käytöstä nuorisopsykiatrisessa vastentahtoisessa osastohoidossa. Tutkimuksen tavoitteena oli kuvata hoitajien, lääkäreiden ja potilaiden asenteita eri rajoittamiskeinoja kohtaan nuorisopsykiatrisessa osastohoidossa, kerätä tietoa yhden vuoden aikana tapahtuneiden sitomisten määrästä ja luonteesta sekä kuvata potilaiden kokemuksia sitomisesta nuorisopsykiatrisen osastohoidon aikana. Tutkimus tuottaa arvokasta tietoa korkeatasoisten sitomiskäytäntöjen kehittämiseen nuorisopsykiatrisessa osastohoidossa, sekä sitomisten määrää vähentämällä että sitomistapoja kehittämällä. Tavoitteena on parantaa sidottujen potilaiden kliinistä hoitoa. Tutkimusaineisto kerättiin suomalaisilla, pääkaupunkiseudulle sijoittuvilla, nuorisopsykiatrisilla osastoilla neljässä vaiheessa lokakuun 2009 ja huhtikuun 2012 välisenä aikana. Helsingin ja Uudenmaan sairaanhoitopiirin (HUS) nuorisopsykiatrian erikoisalan seitsemän suljetun osaston hoitohenkilökunta sekä lääkärit suhtautuivat myönteisesti rajoittamistoimenpiteisiin. Nuorisopsykiatriset potilaat suhtautuivat rajoittamistoimenpiteisiin kriittisemmin kuin henkilökunta. Nuoret suhtautuivat myönteisimmin tarvittaessa annettavaan lääkitykseen, ajoittaiseen tarkkailuun ja kulun rajoittamiseen. Vähiten hyväksytty menetelmä oli verkkosänky. Nuoret arvioivat sitomisen kolmen vähiten hyväksytyn menetelmän joukkoon. Sitomisen esiintyvyys ja pitkien sitomisten määrä olivat korkeita tutkimukseen valituissa yksiköissä. Useimmat sidotut nuoret tiesivät syyn sitomiseensa, suhtautuivat siihen ambivalentisti nähden siinä sekä hyötyä että haittaa, pitäen sitä kuitenkin rangaistuksena. Huolimatta tästä, suurin osa haastatelluista nuorista koki, että joissain tilanteissa sitomista tarvitaan nuorisopsykiatrisessa osastohoidossa. Nuorilla oli monia ehdotuksia, kuinka parantaa sitomista käytännön osastohoidossa. Tämä väitöskirja tuottaa uutta tietoa eri rajoittamistoimenpiteiden ja sitomisen toteuttamisesta nuorisopsykiatrisessa osastohoidossa. Käytännön hoitotyön parantamiseksi nuorisopsykiatrisilla osastoilla tarvitaan laaja-alaista ja syvälle luotaavaa koulutusta, jotta rajoittamis-toimenpiteiden määrää voidaan vähentää. Myös kriisitilanteiden hallintaan tarvitaan uusia keinoja. Tietoa, kuvausta toimenpiteistä ja tilanteiden käsittelyä jälkikäteen tulee tarjota ala-ikäiselle potilaalle hänen kehitystasonsa huomioiden. Sitomisten määrää tulee vähentää ja niiden kestoa lyhentää. Nuorten tulee olla aktiivisesti mukana kehittämässä aggression hallintamenetelmiä suomalaisessa nuorisopsykiatrisessa osastohoidossa.

Behavioral characteristics of the offspring of adolescent rats

The aim of this study was to test the hypothesis that, during adulthood, the offspring of adolescent rats differ in emotionality, learning and memory from the offspring of adult rats. The behavior of the offspring of adolescent (age, 50-55 days) and adult rats (age, 90-95 days) was tested in the open field, activity cage, and passive and active avoidance apparatus. The latencies during training and testing in the passive avoidance apparatus of the offspring of adolescent parents were shorter than the latencies of control offspring (P<0.001 on both training and testing days). Offspring of adolescent parents showed shorter latency time in acquisition trials during active avoidance testing compared to control offspring (P<0.001). They also showed a higher number of active avoidance responses in the last four blocks of acquisition (P<0.001) and first two blocks of extinction trials (P<0.05 and P<0.001, respectively). The offspring of adolescent parents showed higher latency on the first day of testing in the open field (P<0.01) and a lower latency on the third day of testing (P<0.01). They also showed higher activity during all three days of testing (1st and 2nd day: P<0.01; 3rd day: P<0.05). The spontaneous activity of the offspring of adolescent parents in the activity cage was higher in the last three intervals of testing (P<0.001). In summary, the offspring of adolescent parents were less anxious and tended to be more active. The results of two learning and memory tests were opposite, but could be explained by a higher exploratory drive of the offspring of adolescent parents. This was probably due to chronic malnutrition stress and the disturbed mother-infant relationship in the litters of adolescent mothers.

The relationship between salivary cortisol concentrations and anxiety in adolescent and non-adolescent pregnant women

The main purpose of the present study was to determine the relationship between salivary cortisol concentrations and self-report anxiety in 50 adolescent and 178 non-adolescent women during the last month of pregnancy. The subjects were randomly selected from a previous study involving women who attended antenatal care from September 1997 to August 2000 at 17 health services in Southeast Brazil. Salivary cortisol was measured with an enzyme immunoassay kit, and anxiety was assessed by the State-Trait Anxiety Inventories (STAI) of Spielberger. After saliva collection, the participants completed the STAI. Mean concentrations of cortisol for both pregnant adolescents (14.17 ± 6.78 nmol/l) and non-adolescents (13.81 ± 8.51 nmol/l) were similar (P = 0.89). Forty-three percent of the pregnant adolescents and 30.5% of the non-adolescents felt anxious at the time of being questioned (State Anxiety Inventory (SAI) scores >40; P = 0.06). Cortisol concentrations in adolescents were negatively related to the SAI scores (r = -0.39; P = 0.01) which assess a temporary condition of anxiety. There was a statistically significant difference in mean cortisol concentrations between adolescents with low (<=40) and high (>40) SAI scores (P = 0.03, t-test), but no differences for non-adolescents. The negative relationship between salivary cortisol concentrations and anxiety scores in adolescents may be due to puberty-related hormone differences during this period of life. Pregnant adolescents may possess unique biological or psychological characteristics compared to adults and non-pregnant adolescents. Thus, we need to know more about the hypothalamic-pituitary-adrenocortical axis of pregnant adolescents.