Une approche psychanalytique de la notion de dangerosité. Violence et subjectivation : le risque de la rencontre

Après avoir situé la question de la dangerosité dans les perspectives psychiatriques actuelles, l'auteur propose de penser cette notion complexe dans un renversement du paradigme couramment admis : ainsi la référence à la dangerosité témoignerait-elle, au premier plan, de la part non symbolisée de la rencontre de la violence. Cette proposition prend appui dans un premier temps sur les propositions esquissées par M. Foucault dans sa compréhension du rapport à la violence et à la dangerosité. Puis, le recours au concept psychanalytique d'identification projective permet de proposer une modélisation clinique de la dangerosité, qui sera discutée à partir de deux observatoires dans le champ des violences sexuelles : celui d'une recherche menée auprès d'adolescents engagés dans des agirs sexuels violents et celui d'une pratique d'expertise judiciaire. First the author proposes to situate dangerousness's question in actual psychiatric field. Then, he proposes to think this complex notion into a reversal of dangerousness's paradigm: the reference to dangerousness will be thought as the expression of non-symbolized part through violence's meeting. This proposition relies in a first time on M. Foucault's propositions about a comprehension of the relation with violence and dangerousness. In a second time, the psychoanalytic concept of projective identification allows to propose clinical comprehension of dangerousness's notion. Two clinical situations about sexual violences will be asked in this plan: a research with Young sexual offenders and practice of judiciary evaluation.

The interconnection of somatic and mental issues within a multidisciplinary adolescent health unit. [L'intrication des problématiques somatiques et psychiques dans une unité multidisciplinaire de santé des adolescents.]

Les aspects physiques et psychiques sont étroitement intriqués à l'adolescence, et le corps représente un lieu privilégié d'expression des conflits. C'est dire l'importance de donner une place de choix au versant psychologique au sein d'une consultation de santé des adolescents, pour tenter de discerner la souffrance psychique souvent cachée derrière la plainte somatique.

Substance use and depression. Comparative course in adolescents.

OBJECTIVE: To examine the relation between depression and substance use in adolescents and the concomitant courses of both disorders. METHODS: Four individual interviews were administered to 85 adolescent substance users aged 14-19 years (mean 17.1 years, SD 1.4) over a 3.5 year period using the Adolescent Drug Abuse Interview (ADAD) and the Beck Depression Inventory (BDI-13). RESULTS: No predictive effect was observed on one dimension over the other, but each dimension was predictive of its own course. A decrease in substance-use severity paralleled a decrease in depressive state. Similarly, stable substance-use rates, either at a low or a high level, tended to be associated with low or high levels of depression, respectively. However, an increase in substance use was not accompanied by an increase in depressive states. Moreover, depression varied greatly between adolescents, and according to gender and age. CONCLUSIONS: Depressive states and substance use in adolescents can vary considerably overtime, and are closely but rather synchronically related. Since most of the adolescents do not seek help for substance-related problems, substance use should be systematically assessed in adolescents presenting with a depressive state.

Treatment motivation in adolescents with psychosis or at high risk: Determinants and impact on improvements in symptoms and cognitive functioning, preliminary results.

Abstract Low motivation is frequent in chronic disorders such as psychosis and may limit treatment efficacy. Although some evidence supports this view in adults, few studies so far have focused on adolescents. We assessed the impact of baseline symptoms, cognitive deficits and cognitive treatment characteristics on treatment motivation (TM), and examined whether TM affected treatment outcome. Twenty-eight adolescents with psychotic disorders participated in 16 sessions of computerized cognitive remediation or games. TM was assessed for each session. Lower TM was predicted by more severe symptoms at baseline, and was associated with smaller improvements in symptoms and both cognitive and psychosocial functioning at the end of the intervention. Experiencing success in the treatment exercises enhanced TM in all patients.

Qualités psychométriques de la version française de la TAS-20 et prévalence de l'alexithymie chez 264 adolescents tout-venant [The 20-item Toronto alexithymia scale: structural validity, internal consistency and prevalence of alexithymia in a Swiss adolescent sample]

L'objectif de cette étude est d'examiner la structure factorielle et la consistance interne de la TAS-20 sur un échantillon d'adolescents (n = 264), ainsi que de décrire la distribution des caractéristiques alexithymiques dans cet échantillon. La structure à trois facteurs de la TAS-20 a été confirmée par notre analyse factorielle confirmatoire. La consistance interne, mesurée à l'aide d'alpha de Cronbach, est acceptable pour le premier facteur (difficulté à identifier les sentiments (DIF)), bonne pour le second (difficulté à verbaliser les sentiments (DDF)), mais en revanche, faible pour le troisième facteur (pensées orientées vers l'extérieur (EOT)). Les résultats d'une Anova mettent en évidence une tendance linéaire indiquant que plus l'âge augmente plus le niveau d'alexithymie (score total TAS-20), la difficulté à identifier les sentiments et les pensées orientées vers l'extérieur diminuent. En ce qui concerne la prévalence de l'alexithymie, on remarque en effet que 38,5 % des adolescents de moins de 16 ans sont considérés comme alexithymiques, contre 30,1 % des 16-17 ans et 22 % des plus de 17 ans. Notre étude indique donc que la TAS-20 est un instrument adéquat pour évaluer l'alexithymie à l'adolescence, tout en suggérant quelques précautions étant donné l'aspect développemental de cette période.

Adolescent Drug Abuse Diagnosis (ADAD) vs. Health of Nation Outcome Scale for Children and Adolescents (HoNOSCA) in clinical outcome measurement.

BACKGROUND: The Adolescent Drug Abuse Diagnosis (ADAD) and Health of Nation Outcome Scales for Children and Adolescents (HoNOSCA) are both measures of outcome for adolescent mental health services. AIMS: To compare the ADAD with HoNOSCA; to examine their clinical usefulness. METHODS: Comparison of the ADAD and HoNOSCA outcome measures of 20 adolescents attending a psychiatric day care unit. RESULTS: ADAD change was positively correlated with HoNOSCA change. HoNOSCA assesses the clinic's day-care programme more positively than the ADAD. The ADAD detects a group for which the mean score remains unchanged whereas HoNOSCA does not. CONCLUSIONS: A good convergent validity emerges between the two assessment tools. The ADAD allows an evidence-based assessment and generally enables a better subject discrimination than HoNOSCA. HoNOSCA gives a less refined evaluation but is more economic in time and possibly more sensitive to change. Both assessment tools give useful information and enabled the Day-care Unit for Adolescents to rethink the process of care and of outcome, which benefited both the institution and the patients.

Female adolescents' views on a youth-friendly clinic.

OBJECTIVE: To assess satisfaction among female patients of a youth friendly clinic and to determine with which factors this was associated. METHODS: A cross-sectional survey was conducted in an adolescent clinic in Lausanne, Switzerland, between March and May 2008. All female patients who had made at least one previous visit were eligible. Three hundred and eleven patients aged 12-22 years were included. We performed bivariate analysis to compare satisfied and non-satisfied patients and constructed a log-linear model. RESULTS: Ninety-four percent of patients were satisfied. Satisfied female adolescents were significantly more likely to feel that their complaints were heard, that the caregiver understood their problems, to have no change of physician, to have received the correct treatment/help and to follow the caregiver's advice. The log-linear model highlighted four factors directly linked with patient satisfaction: outcome of care, continuity of care, adherence to treatment and the feeling of being understood. CONCLUSIONS: The main point for female adolescent patient satisfaction lies in a long term, trustworthy relationship with their caregiver. Confidentiality and accessibility were secondary for our patients.

Sports practice among adolescents with chronic health conditions.

OBJECTIVES: To compare the level of sports practice between adolescents with chronic health conditions (CHCs) and control peers and to examine the reasons given by adolescents with CHCs for not practicing any sports in comparison with the control group. DESIGN: School survey. SETTING: Postmandatory schools. PARTICIPANTS: A total of 6790 students (3275 females) aged 16 to 20 years, grouped as adolescents with CHCs (355 females, 354 males) and control peers (2920 females, 3161 males). MAIN EXPOSURE: Chronic health condition was defined using a noncategorical approach including adolescents with a chronic disease and/or a physical handicap. MAIN OUTCOME MEASURES: Sports practice, barriers to sports practice among individuals not practicing any sports, and biological, psychological, socioeducative, and physical activity characteristics. RESULTS: Males with CHCs were less likely than control males to practice sports, whereas no significant difference was observed for females. Chronically ill youth were significantly more likely to report having a CHC as a barrier for not practicing sports. However, the most frequently reported barrier was preference for other activities for males with CHCs and lack of time for control males and for females with and without CHCs. CONCLUSIONS: Having a CHC seems to influence sports practice among males but not females. We recommend that practitioners dealing with adolescents remember to take into account sports practice as part of the care of young patients with CHCs.

On the fate of sexual traits under asexuality.

Environmental shifts and life-history changes may result in formerly adaptive traits becoming non-functional or maladaptive. In the absence of pleiotropy and other constraints, such traits may decay as a consequence of neutral mutation accumulation or selective processes, highlighting the importance of natural selection for adaptations. A suite of traits are expected to lose their adaptive function in asexual organisms derived from sexual ancestors, and the many independent transitions to asexuality allow for comparative studies of parallel trait maintenance versus decay. In addition, because certain traits, notably male-specific traits, are usually not exposed to selection under asexuality, their decay would have to occur as a consequence of drift. Selective processes could drive the decay of traits associated with costs, which may be the case for the majority of sexual traits expressed in females. We review the fate of male and female sexual traits in 93 animal lineages characterized by asexual reproduction, covering a broad taxon range including molluscs, arachnids, diplopods, crustaceans and eleven different hexapod orders. Many asexual lineages are still able occasionally to produce males. These asexually produced males are often largely or even fully functional, revealing that major developmental pathways can remain quiescent and functional over extended time periods. By contrast, for asexual females, there is a parallel and rapid decay of sexual traits, especially of traits related to mate attraction and location, as expected given the considerable costs often associated with the expression of these traits. The level of decay of female sexual traits, in addition to asexual females being unable to fertilize their eggs, would severely impede reversals to sexual reproduction, even in recently derived asexual lineages. More generally, the parallel maintenance versus decay of different trait types across diverse asexual lineages suggests that neutral traits display little or no decay even after extended periods under relaxed selection, while extensive decay for selected traits occurs extremely quickly. These patterns also highlight that adaptations can fix rapidly in natural populations of asexual organisms, in spite of their mode of reproduction.

Correlates of extracurricular sport participation among Swiss adolescents.

BACKGROUND: Based on a large national survey on the health of adolescents, this paper focuses on the socio-demographic and lifestyle correlates of sport practice among Swiss adolescents. The SMASH2002 database includes 7428 vocational apprentices and high school students between the ages of 16 and 20 who answered a self-administered anonymous questionnaire containing 565 items targeting perceived health, health attitudes and behaviour. Weekly episodes of extracurricular sport activity were measured by a four-category scale, and the sample was dichotomised between active (>or=two episodes of sport/week) and inactive (<two episodes of sport/week) respondents. Thirty percent of female respondents and 40.2% of male respondents reported engaging in sport activity at least two to three times a week; another 9.7% of the female and 19.4% of the male respondents reported participating in least one sport activity each day (p<0.01). The percentage of active respondents was higher among students than among vocational apprentices (p<.01), and the rates of sport activity decreased more sharply over time among the apprentices than among the students (p<0.01). Most active adolescents reported having a better feeling of well-being than their inactive peers [among male students: odds ratio (OR): 3.13; 95% confidence interval (95%CI): 1.28-7.70]. The percentage of active females who reported being on a diet was high, and female apprentices exhibited higher involvement in dieting than their inactive peers (OR: 1.68; 95%CI: 1.32-2.14). Relative to the inactive male respondents, the proportion of active male respondents smoking was lower; however, a lower proportion of the latter group did not report drunkenness, and the percentage of those who reported lifetime cannabis consumption was higher among active than inactive students (females, OR:1.57; 95%CI:1.09-2.25; males, OR:1.80; 95%CI: 20-2.69). CONCLUSION: Organised sport activities should be better tailored to the work schedules of apprentices. Practitioners should be aware of the potential for problematic behaviour in the area of dieting and substance use among a subset of sport-oriented adolescents.

Sexual dysfunction among young men : prevalence and associated factors

Les dysfonctions sexuelles représentent une préoccupation importante et parfois mésestimée dans la population masculine générale. L'éjaculation précoce et les dysfonctions érectiles faisant partie des dysfonctions sexuelles les plus fréquentes, nous avons choisi, dans le présent article, de nous concentrer sur ces deux aspects. Selon plusieurs études, la prévalence d'éjaculation précoce se situe entre 17 et 30%. Les associations décrites avec l'éjaculation précoce concernent le stress, la dépression et un jeune âge (<25 ans). La prévalence de dysfonction érectile, quant à elle, oscille entre 2 et plus de 80% dépendant principalement de l'âge. Beaucoup d'autres facteurs associés ont été décrits dans la littérature, tels que le diabète, les pathologies cardiovasculaires ou neurologiques, les médicaments, l'obésité ou l'inactivité physique. Tous ces facteurs étant plus fréquents au sein de populations vieillissantes, nous disposons de peu d'études concernant la dysfonction érectile chez de jeunes hommes. Notre étude propose donc d'évaluer la prévalence d'éjaculation précoce et de dysfonction érectile chez une population de jeunes hommes et d'étudier les associations possibles avec les consommations de substances, l'index de masse corporelle (IMC), l'activité physique ou la santé mentale. Chaque homme suisse entre 18 et 25 ans est appelé à participer à 2 journées de recrutement militaire. De septembre 2010 à mai 2011, les jeunes hommes recrutés à Lausanne et à Zürich (N= 9761) ont été invités à participer à l'étude C-SURF (Cohort Study on Substance Use Risk Factors). 5276 d'entre eux acceptèrent de répondre au questionnaire complet, et 73% (N=3886) le firent de manière effective. Le but de notre recherche étant d'étudier les dysfonctions sexuelles, nous nous sommes concentrés sur les participants sexuellement actifs (N=2507) et les avons divisés en 2 groupes, selon qu'ils présentaient ou non la dysfonction étudiée. Pour chaque dysfonction (éjaculation précoce et dysfonction érectile), nous avons utilisé une analyse bivariée afin de comparer les deux groupes (avec ou sans trouble) quant à d'éventuels facteurs associés. A cause de la nature transversale de l'étude, nous ne pouvions pas postuler de lien de cause à effet entre ces facteurs et les dysfonctions sexuelles, raison pour laquelle nous avons choisi d'utiliser des modèles log-linéaires pour mettre en exergue les associations significatives. Nos résultats montrent une prévalence d'éjaculation précoce de 11.4% avec comme associations principales la consommation de tabac et de drogues illégales (autres que le cannabis). La prévalence des dysfonctions érectiles est quant à elle proche du 30% et s'associe principalement avec l'usage de médicaments, ainsi qu'avec la santé physique et la santé mentale. Un jeune homme suisse sur trois souffre ainsi d'au moins une dysfonction sexuelle. Beaucoup de facteurs compromettants pour la santé y sont possiblement associés, raison pour laquelle les professionnels de la santé devraient saisir chaque occasion pour parler de sexualité avec leurs jeunes patients de sexe masculin.

Implicit attitudes and self-concepts towards transgression and aggression: Differences between male community and offender adolescents, and associations with psychopathic traits.

Research suggests that implicit attitudes play a key role in the occurrence of antisocial behaviours. This study assessed implicit attitudes and self-concepts related to aggression and transgression in community and offender adolescents, using a new set of Implicit Association Tests (IATs), and examined their association with of psychopathic traits. Thirty-six offenders and 66 community adolescents performed 4 IATs assessing 1) implicit attitudes about a) aggression and b) transgression as good, and 2) implicit self-concepts about a) aggression and b) transgression as self-descriptive. They filled in self-report questionnaires: the Youth Psychopathic Traits Inventory, the Child Behaviour Checklist, and explicit measures of their attitudes and self-concepts towards transgression and aggression. Results showed few differences between community and offender adolescents on implicit attitudes and self-concepts, and unexpected negative associations between some implicit attitudes and psychopathic traits, while the association was positive for the corresponding explicit attitudes. Possible explanations of these findings are discussed.

Genetics of decayed sexual traits in a parasitoid wasp with endosymbiont-induced asexuality.

Trait decay may occur when selective pressures shift, owing to changes in environment or life style, rendering formerly adaptive traits non-functional or even maladaptive. It remains largely unknown if such decay would stem from multiple mutations with small effects or rather involve few loci with major phenotypic effects. Here, we investigate the decay of female sexual traits, and the genetic causes thereof, in a transition from haplodiploid sexual reproduction to endosymbiont-induced asexual reproduction in the parasitoid wasp Asobara japonica. We take advantage of the fact that asexual females cured of their endosymbionts produce sons instead of daughters, and that these sons can be crossed with sexual females. By combining behavioral experiments with crosses designed to introgress alleles from the asexual into the sexual genome, we found that sexual attractiveness, mating, egg fertilization and plastic adjustment of offspring sex ratio (in response to variation in local mate competition) are decayed in asexual A. japonica females. Furthermore, introgression experiments revealed that the propensity for cured asexual females to produce only sons (because of decayed sexual attractiveness, mating behavior and/or egg fertilization) is likely caused by recessive genetic effects at a single locus. Recessive effects were also found to cause decay of plastic sex-ratio adjustment under variable levels of local mate competition. Our results suggest that few recessive mutations drive decay of female sexual traits, at least in asexual species deriving from haplodiploid sexual ancestors.

Adolescents immigrats a Catalunya i construcció de la identitat cultural: trajectòries de vida i processos d’inclusió

Aquest projecte de recerca es proposa construir coneixement sobre les diverses formes en què els adolescents de família immigrada elaboren la seva identitat cultural, amb la finalitat d’establir pautes i propostes d’intervenció educativa que els ajudin a evitar, a causa de la interacció social en contextos multiculturals, l’exclusió social per motius d’ètnia o cultura. La recerca es du a terme en quatre fases. Una primera fase està destinada a recollir informació qualitativa sobre com construeixen aquests adolescents la seva identitat cultural. La segona fase consisteix en elaborar, de forma fonamentada i d’acord amb la informació obtinguda, un programa d’activitats educatives per aplicar. Aquesta fase es complementa amb una tercera d’experimentació del programa i avaluació dels resultats obtinguts, per poder dedicar-se posteriorment a la quarta i última, centrada en la difusió entre tots els centres de secundària vinculats a l’Institut de Ciències de l’Educació de la UAB. El projecte es desenvolupa en el marc del Campus Ítaca, una iniciativa de la UAB per acostar-se a l’alumnat que cursa estudis d’ESO. El Campus Ítaca pretén, mitjançant el desenvolupament de diverses activitats, que els alumnes de secundària es motivin a continuar els seus estudis en etapes postobligatòries. Es treballa, per tant, amb l’alumnat immigrat dels centres de secundària que hi participen.