INTRODUCTION: This study aims to assess the economic impact of delays and inadequate diagnosis and treatment for neurodevelopmental disorders (NDDs) in France, affecting 2 to 3 million individuals. Neurodevelopmental dis...INTRODUCTION: This study aims to assess the economic impact of delays and inadequate diagnosis and treatment for neurodevelopmental disorders (NDDs) in France, affecting 2 to 3 million individuals. Neurodevelopmental disorders, including autism spectrum disorder (ASD), learning disabilities, and attention deficit hyperactivity disorder (ADHD), are often described as "invisible" disabilities, but they generate significant societal costs. METHOD: The study was conducted with the support of Ashoka France as part of a collaboration between Goodwill-Management and the Aloïs Association. Goodwill-Management, a firm specializing in support for social economy organizations, offers pro bono assistance each year for social impact assessment. In 2022, it selected the project of the Aloïs Association, a center of expertise on cognitive disorders at all stages of life, based in Paris, to conduct the first medico-economic study on NDDs in France. The methodological approach comprised a thorough literature review, data collection from public organizations, and detailed economic analysis. The study sought to identify the potential cost-saving levers and highlight the economic burden of late diagnosis and variable care pathways for NDDs. RESULTS: The study revealed that the economic cost of NDDs in France is estimated at approximately 28 billion euros per year. In comparison, the estimated costs are 74 billion dollars in the United States and 37 billion dollars in Canada. A major contributor to these costs is the delay in diagnosis, coupled with the heterogeneity of care, which significantly impacts the professional lives of individuals with NDDs and their caregivers. CONCLUSION: The findings underscore the importance of early diagnosis and standardized care pathways to reduce societal costs and improve the quality of life for affected individuals. To reduce societal costs and improve the quality of life for those affected, the proposed recommendations emphasize the importance of early diagnosis, increasing access to care methods recommended by the HAS (French National Health Authority), and promoting targeted prevention and psychoeducation interventions within companies, aimed at supporting employees suffering from these disorders as well as employee caregivers. Implementing these measures is expected to generate substantial economic savings and support the inclusion and well-being of individuals with neurodevelopmental conditions.
BACKGROUND: Borderline personality disorder (BPD) is a complex mental health condition characterized by emotional, relational, and cognitive dysregulations. It is often misdiagnosed or underdiagnosed, contributing to sti...BACKGROUND: Borderline personality disorder (BPD) is a complex mental health condition characterized by emotional, relational, and cognitive dysregulations. It is often misdiagnosed or underdiagnosed, contributing to stigmatization and inconsistent treatment. The COVID-19 pandemic, with its unique stressors, offered an opportunity to examine BPD traits in the general population. AIMS: This study compares the manifestation of BPD traits during the COVID-19 pandemic across clinical and non-clinical populations in France. It hypothesizes that the general population, despite experiencing similar stress-induced behaviors, will exhibit different levels of BPD traits. METHODS: We administered the Borderline Personality Questionnaire (BPQ), Impulsive Behavior Scale (UPPS), and Beck Hopelessness Scale (BHS) to a sample of 563 respondents via an online questionnaire. RESULTS: The findings reveal that while all groups exhibited elevated impulsivity and anxiety, BPD patients exhibited significantly higher levels of hopelessness, suicidal tendencies, anxiety and depression. This indicates the chronic and pervasive nature of BPD compared with stress-induced behaviors in the general population or other clinical samples. DISCUSSION: The results highlight the distinct nature of BPD traits and the necessity of refined diagnostic and treatment approaches. We specifically note that the "Emptiness" trait affects the overall severity of BPD. The analysis allows for the nuanced understanding that BPD, rather than being a unified pathological entity, is a disorder in which predominant traits can affect the overall severity. CONCLUSION: BPD is a prevalent yet underdiagnosed disorder, with traits such as chronic emptiness remaining stable despite external stressors such as the COVID-19 pandemic. Focusing on understudied traits such as emptiness could enhance therapeutic approaches, and further research is needed to refine diagnostic methods and better understand BPD's diverse symptom profiles.
OBJECTIVES: Psychiatric comorbidities are frequent in anorexia nervosa, non-suicidal self-injury being one of the more frequent. The aim of this study was to review the literature exploring the links between these disord...OBJECTIVES: Psychiatric comorbidities are frequent in anorexia nervosa, non-suicidal self-injury being one of the more frequent. The aim of this study was to review the literature exploring the links between these disorders and thus to improve our understanding of their causality, risks, and consequences. METHOD: We used electronic searches in Pubmed, Cochrane, PsychInfo, and Web of Science to conduct a systematic scoping review of the publications dealing with the association between non-suicidal self-injury and anorexia nervosa published through November 2023. RESULTS: The study finally included thirty-three studies, mainly of female adolescents and young women, and most frequently from an epidemiological perspective. The results confirmed a frequent association between non-suicidal self-injury and anorexia nervosa, and a significantly higher prevalence of such self-injury in the anorexia subtype involving binge-eating/purging than in the purely restrictive subtype. This result appears to confirm an earlier finding that only the diagnosis of anorexia nervosa with binge-eating/purging behaviours predicts the occurrence of non-suicidal self-injury during eating disorder. In addition, results reported that the risks of psychiatric comorbidities and of suicide were higher and that the treatment of anorexia was longer and the weight gain slower in those patients. CONCLUSIONS: This study confirmed the association between these two disorders which makes their management more complex. More rapid identification of non-suicidal self-injury in anorexia nervosa and a better understanding of its underlying psychopathological processes are needed to propose appropriate multidisciplinary care. More systematic studies on the associations between these disorders are essential.
AIM AND SCOPE: This article aims to explore the relationships between two key levels (Criteria A and B) in the Alternative Model of Personality Disorders (AMPD). Specifically, it examines the articulation between the lev...AIM AND SCOPE: This article aims to explore the relationships between two key levels (Criteria A and B) in the Alternative Model of Personality Disorders (AMPD). Specifically, it examines the articulation between the level of personality functioning (LPF) and the pathological personality dimensions (PPD) to understand their respective contributions to personality disorder (PD) diagnosis. METHOD: We analyzed data collected through the LPFS-BR and PID-5-BF instruments from two randomized samples of non-clinical participants, gathered both before (n=124) and after (n=126) the COVID-19 pandemic and subsequent lockdown. Mediation analyses were conducted to clarify how LPF and PPD interact in the assessment of PDs. RESULTS: Findings indicate notable intensity differences in LPF levels (P<0.001, Cohen's d>0.92), alongside high stability in both overall PD severity and PPD traits (P>0.05). Regression analysis allowed us to examine the combined effects of Lockdown, Identity, and Detachment on PD severity through mediation modelling. Results suggest that Identity mediates the effects of both Lockdown and Detachment, with Detachment also having a direct impact. DISCUSSION: These results indicate that while certain aspects of the AMPD are context-sensitive, the PPD may offset these fluctuations through both direct and indirect mechanisms.
BACKGROUND: Cannabis is the most widely used drug in the world, and the therapies proposed to help withdrawal are moderately effective. The MACBETH project is a pilot study in France. It evaluates the effectiveness of th...BACKGROUND: Cannabis is the most widely used drug in the world, and the therapies proposed to help withdrawal are moderately effective. The MACBETH project is a pilot study in France. It evaluates the effectiveness of the mindfulness-based relapse prevention (MBRP) protocol for active cannabis users. METHODS: It comprises of two groups, an MBRP group and a Treatment As Usual (TAU) group, each with twenty participants. The primary endpoint reflects the frequency of cannabis use, and some secondary endpoints were evaluated (signs of withdrawal, adherence to treatment, and changes in consumption). RESULTS: We found no significant difference between the two groups on the primary and secondary endpoints. We found one significant difference in the MBRP group by further analysis for treatment adherence via an indirect criterion, the attendance at all sessions (P-value=0.01). The number of units consumed from week 1 to week 8 significantly differed in the MBRP group (P-value<0.05) but not in the TAU group. The average number of units consumed from week 8 to 12 increased by 1.5 in the MBRP group compared with 3.4 in the TAU group. The MBRP protocol appears to be at least as effective as the TAU protocol on the assessed criteria, and the results seem to be more durable, although not significant (P-value=0.2). CONCLUSIONS: The MBRP protocol shows interesting results compared to TAU in this major public health problem. Further studies could deepen this field of research, especially by following samples over the long-term and measuring cravings. The MBRP protocol is proving to be an effective and serious alternative psychotherapy to drug therapies in the world of addiction.
"Prison psychosis" is a historical concept that is still used in clinical practice, but little explored in research. In this short paper, we propose to revisit this concept by studying first-episode psychosis (FEP) in th..."Prison psychosis" is a historical concept that is still used in clinical practice, but little explored in research. In this short paper, we propose to revisit this concept by studying first-episode psychosis (FEP) in the prison population. We analyzed a series of incarcerated people who were hospitalized for a FEP from November 2020 to May 2021 in a French facility. We dated the onset of the first psychotic symptoms (PSs) in relation to the date of incarceration and of hospitalization and we calculated the duration of untreated psychosis (DUP). While the characteristics of our sample were consistent with what we know about people diagnosed with psychosis in correctional settings (young men with positive symptoms and psychiatric comorbidities), we found great heterogeneity in the DUP and in the chronological sequence between incarceration and the onset of PSs. This preliminary but original work shows the diversity of first diagnosis of psychosis in prison, reflecting the multiplicity and complexity of interactions between psychosis and incarceration.
OBJECTIVE: The purpose of this study is to analyze professionals' representations of parents with mental and/or physical health conditions. METHODS: We interviewed 51 health professionals and social workers. Using an ind...OBJECTIVE: The purpose of this study is to analyze professionals' representations of parents with mental and/or physical health conditions. METHODS: We interviewed 51 health professionals and social workers. Using an inductive approach and NVivo software, we proceeded to a qualitative analysis. To comprehensively examine the content of professionals' responses, each coding unit was assessed according to its theme (representation of the family, representation of the condition, actions on representations) and valence (negative, cautious, positive or neutral tone). RESULTS: Three major themes emerged from the interviews: 1 - Family representations: The child is vulnerable and negatively impacted by parents with mental and/or physical health conditions. This impact is embodied mostly by the mother, the father being seen as a subsidiary parental function or a potential intermediary. The extended family is invested as a protective factor. 2 - Condition representations: Physical impairment is more positively viewed than mental health conditions, psychosis being particularly negative; physical impairments are seen as more compatible with qualitative parenthood. 3 - Actions on representations: Becoming aware of their representations and reflecting on them allow professionals to think of the unique character of each situation and to put their representations into perspective; time and exposure to parents with health conditions leads them to revise their most negative representations. CONCLUSION: While the results are broadly in line with the literature, this study investigates in detail the previously unexplored point of view of professionals. Revealing their representations may contribute to improving practices and care provided to families with mental and/or physical health conditions.
Major depressive disorder is a complex neuropsychiatric disorder and one of the leading causes of disability in developed countries. Treatment-resistant depression is defined as the failure of at least two adequate treat...Major depressive disorder is a complex neuropsychiatric disorder and one of the leading causes of disability in developed countries. Treatment-resistant depression is defined as the failure of at least two adequate treatment trials. The Muenke Syndrome is an autosomal dominant disorder caused by a mutation of the fibroblast growth factor receptor 3 (FGFR3). The fibroblast growth factor (FGF) family has often been implicated in mood disorders in the literature. We present here the case of a patient with a treatment-resistant depression and a concomitant Muenke Syndrome. We propose a relationship between the two pathologies as the expression of the FGF family has been shown to be dysregulated in depressed humans, post-mortem depressed human's brains and rodent's models of depression and anxiety. In particular, FGFR3 and its major ligand, FGF9, had been shown to be down-regulated and up-regulated, respectively, in cortical areas implicated in mood disorders. Since the FGF family plays a key role in neurodevelopment and neuroplasticity, among others things, a genetic mutation in a member of the family, such as FGFR3, could lead to depressive symptoms, as in our reported case. The implication is that the FGF family may be an important target for the treatment of neuropsychiatric disorders. We also conclude that depressive symptoms should be investigated in cases of Muenke Syndrome, as FGF dysregulation in depressed patients.
This brief article discusses the current state of knowledge on the use of virtual reality in assessing and/or treating body image and body image disturbances among athletes with dysfunctional eating attitudes and behavio...This brief article discusses the current state of knowledge on the use of virtual reality in assessing and/or treating body image and body image disturbances among athletes with dysfunctional eating attitudes and behaviors ( i.e., eating disorders and disordered eating). The scientific void on this subject, as demonstrated by the literature review, clearly demonstrates that more research is needed to fully understand the contribution of virtual reality in in this field.
OBJECTIVE: To understand the clinical characteristics and risk factors of early-onset schizophrenia in children with self-injurious suicide behavior. METHODS: From March 2021 to December 2021, the clinical information of...OBJECTIVE: To understand the clinical characteristics and risk factors of early-onset schizophrenia in children with self-injurious suicide behavior. METHODS: From March 2021 to December 2021, the clinical information of 77 inpatients with demography characteristics, family characteristics, and diseases which met the ICD-10 diagnostic criteria for "schizophrenia" in the pediatric wards of Shanghai Mental Health Center was retrospectively collected. According to whether or not there was self-injurious suicide behavior, they were divided into the self-harm and suicidal behavior group (self-harm and suicidal behavior - S) and the non-self-injurious suicide group (NS); inter-group comparison and regression analysis was performed between the two groups. RESULT: There were 51 cases (66.2%) of early-onset childhood schizophrenia patients with self-injurious suicidal behavior, verbal auditory hallucinations (94.12%) and delusion of reference (92.16%) being the main psychological symptoms. Compared with early-onset schizophrenia patients without self-injurious suicidal behavior, early-onset schizophrenia patients with self-injurious suicidal behavior had a higher incidence of delusion of reference (t=3.184, P=0.002) and command auditory hallucinations (t=2.256, P=0.027). The Eysenck Personality Questionnaire showed that the score of neuroticism was higher (F=4.139, P=0.001); the level of free tetraiodothyronine (FT4) was lower (t=-4.436, P<0.001); and logistic regression analysis showed that gender (P=0.036, OR=14.863), FT4 (P=0.011, OR=0.607) and neuroticism score (P=0.035, OR=1.073) were related to the occurrence of self-injurious suicide in children with early-onset schizophrenia. CONCLUSION: Early-onset schizophrenia patients with self-injurious and suicidal behavior have typical psychiatric symptoms, accompanied by some characteristics associated with emotional instability. Females with low levels of FT4 and neuroticism have risk factors for suicide with self-injury in early-onset schizophrenia.
OBJECTIVES: Physicians demonstrate low rates of help seeking for psychiatric disorders, occupational stress, and burnout due to perceived stigma. The Stigma of Occupational Stress Scale for Doctors (SOSS-D) is a brief st...OBJECTIVES: Physicians demonstrate low rates of help seeking for psychiatric disorders, occupational stress, and burnout due to perceived stigma. The Stigma of Occupational Stress Scale for Doctors (SOSS-D) is a brief standardized tool designed to measure stigma (personal, perceived other, and perceived structural) in physicians. The aim of this study was to gather validity evidence for a French version of the SOSS-D. METHODS: The SOSS-D was translated into French and piloted with 12 physicians. The scale was administered to physicians at the Geneva University Hospitals. We computed descriptive statistics and internal consistency coefficients. Construct validity was analyzed using exploratory (EFA) and confirmatory factor (CFA) analyses. RESULTS: In total, 323 physicians participated in the survey. The internal consistency coefficient for the French SOSS-D was 0.72, 0.55 for the personal stigma subscale, 0.66 for the perceived other stigma subscale, and 0.65 for the perceived structural stigma subscale. CFA indicated a marginal fit. EFA revealed three factors: personal, perceived other, and perceived structural stigma. DISCUSSION: Our findings support the hypothesis that stigma is a multi-dimensional construct. However, the French version of the SOSS-D scale did demonstrate some differences when compared to its English version. Identifying stigmatization beliefs among physicians may allow for increased identification of physicians at risk, and increased communication concerning preventive actions. Moreover, being aware of and fighting stigma can reduce barriers to help seeking and increased access to care resources for burnt-out physicians. CONCLUSION: The results provide evidence of the validity and reliability of the French version of the SOSS-D indicating its suitability for use in a French-speaking physician population.
There is a tension in contemporary clinical care between generalization, as required in the scientific process of evidence-based medicine, and personalization, as required for the autonomy and care's meaning of an always...There is a tension in contemporary clinical care between generalization, as required in the scientific process of evidence-based medicine, and personalization, as required for the autonomy and care's meaning of an always unique patient. We present here some of the key elements of values-based practice, a shared decision-making process that aims to reconcile these two major trends in clinical care. Values practice is rooted in pioneer work about values from 'ordinary language' analytic philosophy (the 'Oxford School'). As such, it has developed in response to key insights from ways of thinking the world, highlighting the universality of values in care. Values-based practice is a partner to both evidence-based practice and ethics for supporting shared decision-making when complex and sometimes conflicting values are is in play. The story of Mrs Jones' knee, an everyday situation of surgical care, and the Montgomery ruling, a famous legal case from the UK Supreme Court, show why it is so essential to incorporate the values of the individual patient within a model of shared decision-making. Values-based practice relies on learnable clinical skills allowing clinicians to take into account the actual values of every unique person involved in a unique situation. This is required if precision medicine is to deliver genuinely personalized medicine as the basis of truly person-centred clinical care.
In bioethics, patient autonomy is often considered a fundamental principle, even more important than beneficence, non-maleficence and justice. Inspired by liberal philosophies (such as J.S. Mill) and the morality of duty...In bioethics, patient autonomy is often considered a fundamental principle, even more important than beneficence, non-maleficence and justice. Inspired by liberal philosophies (such as J.S. Mill) and the morality of duty (especially Kant), this principle recognizes human dignity and the right of each individual to make free decisions about their health. In practice, this means that health professionals are obliged to provide patients with clear information and obtain their informed consent, while respecting professional confidentiality. In psychiatry, however, this principle is particularly challenging. Mental disorders can affect patients' capacity to make decisions, thereby compromising their autonomy. Delicate situations arise when a psychotic or severely depressed patient refuses necessary care. Carers then face an ethical dilemma: should they impose treatment 'for the good' of the patient, at the risk of adopting a paternalistic approach that is now frowned upon? This dilemma reveals a tension between individual autonomy and the reality of human vulnerability. Some ethicists propose a more relational approach to autonomy, in which the patient's choices are supported by those around him and by carers, creating a framework in which autonomy is exercised in interdependence. From this perspective, helping patients does not negate their autonomy, but rather supports it. Finally, in psychiatry, respect for autonomy must be nuanced, allowing in some cases the use of restricted care to protect the fundamental interests of the patient and those around him or her.
Ethics issues relative to nursing practice in psychiatry raise consistent questioning, requiring a decision-making process based on ethical foundations. The questions relating to the patient's information, his informed c...Ethics issues relative to nursing practice in psychiatry raise consistent questioning, requiring a decision-making process based on ethical foundations. The questions relating to the patient's information, his informed consent to care and the deprivation of his liberty will be detailed in the context of the caregiver-patient relationship, which must be therapeutic but above all symmetrical.
The ethics committee for biomedical research of Casablanca (CERBC) was born within the Faculty of Medicine and Pharmacy of Casablanca (FMPC) in Morocco in 1989, following the impetus of some teachers who were aware, from...The ethics committee for biomedical research of Casablanca (CERBC) was born within the Faculty of Medicine and Pharmacy of Casablanca (FMPC) in Morocco in 1989, following the impetus of some teachers who were aware, from their specialties and their concerns, to the protection of people who took part in clinical trials. From the start, the committee faced difficulties in giving itself regulatory legitimacy. Subsequently, it was necessary to make a major educational and communication effort with the medical staff in order to explain the notions of ethics and bioethics, which were unknown at the time to most of the doctors at the University Hospital. However, general medical ethics teaching has been provided to medical students at the Casablanca faculty since 1979. Thirty-five years after its creation, the sustainability of the CERBC is only due to the perseverance of its members and their activism with all authorities that directly or indirectly affect biomedical research in Morocco.
OBJECTIVES: The Convention on the Rights of Persons with Disabilities (CRPD) is a landmark international treaty which embeds the human rights of people with disabilities, including mental disabilities, into international...OBJECTIVES: The Convention on the Rights of Persons with Disabilities (CRPD) is a landmark international treaty which embeds the human rights of people with disabilities, including mental disabilities, into international law. We aim to demonstrate the relevance of the CRPD for the protection of human rights of people with mental illness in France. We begin with a broad overview of its development and implementation at the level of the international community, and then describe the situation in France. CONCLUSION: Ratification of the CRPD by France in 2010 reflected the increasing recognition of human rights of people with disabilities. To date, the CRPD has inspired several initiatives in the field of mental health in France. As it is at the international level, in France, there remains significant room for advancement; particularly concerning the promotion and protection of economic, social and cultural rights, in addition to that of civil and political rights. Full realization of the principles of the CRPD requires input from all sectors of government and the whole of the community.