Anne-Emmanuelle Ambresin

Les compétences socioémotionnelles (CSE) sont un facteur protecteur de la santé mentale et de la réussite scolaire des adolescentes et des adolescents. Basés sur une approche co-constructive, trois modules de formation aux CSE ont été dispensés au corps enseignant d’une école régulière secondaire du Canton de Vaud, en Suisse. Les résultats préliminaires montrent des améliorations importantes en matière de posture professionnelle et de bienêtre du corps enseignant, ainsi que des relations plus harmonieuses, notamment entre élèves et le corps enseignant.

L'adolescence est une période de développement et de croissance propice à l’émergence de troubles fonctionnels. Ces derniers peuvent se manifester avec une diversité de symptômes affectant différents systèmes du corps dont les plus fréquents sont les céphalées, les douleurs abdominales et musculo-squelettiques. Parmi les critères diagnostiques l’on retrouve des investigations somatiques approfondies sans cause organique identifiée ainsi qu’un fort impact des symptômes sur le fonctionnement de l’adolescent dans une ou plusieurs sphères de sa vie.

Die Adoleszenz ist eine Zeit der Entwicklung und des Wachstums, die das Auftreten funktioneller Störungen begünstigt. Letztere können sich mit einer Vielzahl von Symptomen manifestieren, die unterschiedliche Organsysteme betreffen. Am häufigsten treten Kopfschmerzen, Bauchschmerzen und Schmerzen am Bewegungsapparat auf.

Training with adolescent simulated patients (ASP) is increasingly recognized as an effective form of teaching interviewing skills with adolescent patients. Beyond the acknowledged effectiveness and satisfaction of training with ASP, little is known on medical students’ actual experience and specific learning needs related to simulated encounters with ASP, as well as factors influencing their learning experience. The aim of this study was an in-depth exploration of medical students’ perspectives about training with ASP. Using a qualitative design with grounded theory methods, we conducted in-field observation of training sessions with ASP and individual interviews with eighteen fourth-year medical students participating in training. When provided with an actual experience in a simulated setting, students go through a process of anticipating then modulating the challenge of the encounter with an adolescent patient. This challenge is influenced and modulated within 3 main dimensions: preconceptions about adolescents, level of experience with adolescent patients and professional distance. This process is also influenced by how students perceive and cope with the educational setting. Training with ASP, as a first concrete experience of an adolescent consultation, is an opportunity to address important aspects of students’ attitudes towards adolescent patients such as students’ preconceptions, personal experiences and feelings that could influence the doctor-patient relationship later on. Training should focus on ways to reflect upon and handle such attitudes and the emotional resonance experienced by medical students.

The authors of the published version of this article inadvertently omitted the table note of the Table 2 under the Appendix section. The complete Table 2 i

The objective of this article is to review how primary care providers – paediatricians, family practitioners, nurse practitioners - could address the use of substances by adolescents and respond to problematic behaviours and situations. Given the highly addictive properties of nicotine, adolescents should be supported in avoiding any consumption of tobacco or quitting if they already do so. Screening and investigation of substance use is usually not difficult, provided that it is processed in a neutral and empathetic atmosphere and securing confidentiality if the adolescent asks for it. Any type of substance use is potentially linked with adverse events such as injuries, violence, unplanned and unsafe sexual experience, alcoholic coma, ‘bad trips’ or unpleasant psychological experiences. As such, substance use should be identified and openly discussed with the adolescent. Moderate intermittent recreational use of legal and illegal substances (mainly alcohol and cannabis) should be carefully monitored over time, as it can lead to problematic use. Problematic use and substance use disorder require various interventions, including motivational interviewing, family counselling and psychotherapy, especially when substance use is linked with mental health disorders. Despite the importance of confidential care, parents or caregivers should be involved in problematic situations as much as possible. What is known: • While problematic use of substances is transient amongst many adolescents, it may be a threat to health and school/professional functioning • Primary care providers (PCPs) can address queries or offer preventive interventions to adolescents who use substances What is new: • Some interview tools can assist PCPs efficiently to identify problematic users of substances • There are effective approaches that PCPs can use to address problematic use by adolescent patients

Objective: This study assesses the impact of a clinical refeeding guideline on weight restoration, length of stay, rate of refeeding complications, and rehospitalizations.Method: This retrospective study included patient records of 107 participants aged 13–55 years with a diagnosis of AN, admitted for at least 7 days for renutrition before and after introduction of the refeeding guideline. Weight evolution graphs were rated by 2 clinical experts independently. Binary logistic regression models were erected to identify clinical outcomes associated independently with the guideline as well as to control for potential confounding by sociodemographic and clinical characteristics at admission.Results: The proportion of patients achieving optimal weight gain after the first 2 weeks increased significantly from 6.3% pre‐guideline to 41.8% post guideline (adjusted odds ratio [AOR] = 37.6; 95% confidence interval [CI], 2.77–510.3; P = 0.006). Average length of hospitalization was reduced from 96.7 (SD 48.3) days pre‐guideline to 62.2 (SD 45.5) days post guideline (AOR = 0.99; 95% CI, 0.97–1.01; P = 0.18). None of the patients developed a full refeeding syndrome. There was no significant change in the rate of rehospitalization: 48.5% pre‐guideline to 43.2% post guideline (OR = 0.81; 95% CI, 0.36–1.84; P = 0.62).Discussion: The clinical guideline proved highly effective in bolstering weight gain via intensive refeeding procedures while also being safe. Harmonizing clinical practices improves quality of care for patients with anorexia and, interestingly, may decrease costs by cutting average length of stay by a third without increasing the rehospitalization rate.

Nutrition restoration in inpatients with anorexia nervosa (AN) is a core element in treatment, enabling recovery of cognitive functions essential for psychological care. This study aims to identify factors associated with inpatient weight gain.

Objectives: To examine the metabolic profile of adolescents at baseline and to determine the potential predictive power of a 1-month weight gain (WG) on weight changes during longer term second-generation antipsychotic (SGA) treatment. Methods: A retrospective chart review study, including patients between 13 and 18 years of age and treated with SGA, was conducted. Available data at baseline, 1, 3, and 12 months of treatment were recorded. Results: Four hundred fifty-six patients were included, with a median age of 15 years. Ten percent of the patients were obese (>95th percentile) and abdominal obesity (>90th percentile) was observed in 12% of patients. In a subgroup of 42 patients with both baseline, 1, and 3-month weight data available, WG >4.5% after 1 month was found to be the best predictor (sensitivity: 100; specificity: 66; area under the curve: 83) for a WG >15% after 3 months. After adjusting for potential confounders, a threshold of WG >4% was found as being the best predictor. Conclusions: A worrisome prevalence of metabolic disorders was observed in an adolescent psychiatric cohort. In such patients, a WG >4% during the first month of treatment should raise concerns about weight controlling strategies. Further research is needed to confirm the present results and to determine the impact of a 1-month WG on a 1-year weight change.