Adolescents reçus en urgence en psychiatrie infanto-juvénile. Qui sont-ils ? Quel est leur parcours ? Quel suivi social et/ou judiciaire ?

Chatagner, A.; Olliac, Bertrand; Choquet, Luc-Henry; Botbol, Michel; Raynaud, Jean-Philippe

doi:10.1016/j.neurenf.2014.08.003

Cited by 16 publications

(11 citation statements)

References 22 publications

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“…Treatments that begin in urgent circumstances, as is often the case for adolescents with BPD (Chatagner et al, 2015), may take a few shortcuts and omit to provide sufficient orientation to families about the therapeutic process. However, considering higher risks of dropout amongst adolescents with BPD, our results highlight that good practices should include a discussion on all the imponderables that may occur during the normal therapeutic process.…”

Section: Discussionmentioning

confidence: 99%

“…It is particularly prevalent amongst 3 adolescents with suicidal behaviour, as 40 to 70% fail to begin or complete recommended treatment (Burns, Cortell, & Wagner, 2008;Granboulan, Roudot-Thoraval, Lemerle, & Alvin, 2001). A growing body of evidence suggests that Borderline personality disorder (BPD) can be reliably diagnosed prior to 18 years of age (Kaess, Brunner, & Chanen, 2014) and that this disorder is common amongst among youths seeking help for suicidality (Chatagner, Olliac, Choquet, Botbol, & Raynaud, 2015;Greenfield et al, 2015;Nock, Joiner, Gordon, Lloyd-Richardson, & Prinstein, 2006). Adolescents with BPD are heavy users of health care services and are notoriously difficult to engage in a treatment (Chanen, 2015;Loas et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

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Engagement Complications of Adolescents with Borderline Personality Disorder: Navigating Through a Zone of Turbulence

Desrosiers

St-Jean

Laporte

et al. 2020

Preprint

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Background: Premature treatment discontinuation is a widespread phenomenon in child and adolescent mental health services that impacts treatment benefits and costs of care. Studies of specialized care for adolescents with BPD show that almost 40% of them do not complete treatment. Given that recurrence of suicidal behaviour is one of the main symptoms of BPD, and that the presence of past suicidal attempts is a strong predictor of subsequent attempts in young people, difficulties with treatment engagement in this population needs to be given special consideration. The aim of this study was to describe the process of treatment disengagement and identify warning signs that foreshadow dropouts of adolescents with BPD.Methods: A constructivist grounded theory method was used. Thirty-three interviews with 3 groups of informants (adolescent, parent, clinician) were conducted to document 11 treatment trajectories.Results: Disengagement is preceded by engagement complications, which may sometimes go unnoticed. These will unfold according to a three-step sequence starting with negative emotions associated with the appropriateness of treatment, the therapeutic relationship or the vicissitudes of treatment, followed by treatment interfering attitudes and openly disengaged behaviours. These engagement complications lead the way towards the development of a “zone of turbulence” which creates a vulnerable and unstable therapeutic process.Conclusion: Engagement complications which arise during therapy illustrate how the initial engagement of adolescents with BPD and of their parents for treatment is neither static nor certain, but subject to fluctuating emotions and perceptions. This implies that engagement can never be taken for granted and must constantly be monitored during the therapeutic process. Maintaining the engagement of adolescents with BPD should be a therapeutic objective akin to reducing symptomatology or improving psychosocial functioning, and should therefore be given the same attention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Engagement Complications of Adolescents with Borderline Personality Disorder: Navigating Through a Zone of Turbulence

Desrosiers

St-Jean

Laporte

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Une autre étude portant sur les raisons des consultations en urgence en psychiatrie infanto-juvénile des adolescents a rapporté une répartition différente des troubles selon le placement ASE ou non. Ainsi, il était noté une prédominance de pathologies de type borderline, de troubles des conduites et du comportement et moins de troubles névrotiques ou de troubles de l'humeur chez les enfants placés à l'ASE par rapport aux autres adolescents [8]. Toutes ces études, la nôtre comprise, montrent qu'il existe une psychopathologie propre aux adolescents placés.…”

Section: Discussionunclassified

Étude des notifications à la Maison départementale des personnes handicapées chez les enfants placés à l’Aide sociale à l’enfance dans les Bouches-du-Rhône

Montaigne¹,

Bernard²,

Fonseca³

et al. 2015

Archives de Pédiatrie

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“…It is particularly prevalent among adolescents with suicidal behaviour, as 40 to 70% fail to begin or complete recommended treatment (2,3). A growing body of evidence suggests that borderline personality disorder (BPD) can be reliably diagnosed prior to 18 years of age (4) and that this disorder is common among youths seeking help for suicidality (5)(6)(7). Adolescents with BPD are heavy users of health care services and are notoriously di cult to engage in a treatment (8,9).…”

Section: Introductionmentioning

confidence: 99%

Engagement Complications of Adolescents with Borderline Personality Disorder: Navigating Through a Zone of Turbulence

Desrosiers

St-Jean

Laporte

et al. 2020

Preprint

View full text Add to dashboard Cite

Objective: Premature treatment discontinuation is a widespread phenomenon in child and adolescent mental health services that impacts treatment benefits and costs of care. Adolescents with borderline personality disorder (BPD) are heavy users of health care services and notoriously difficult to engage in treatment. However, there is hardly any data regarding this phenomenon with these youths. Considering that BPD treatment is associated with intense and chaotic therapeutic processes, exploring barriers emerging in the course of treatment could be relevant. Thus, conceptualizing treatment dropout as a process evolving from engagement to progressive disengagement, and ultimately to dropout, could highlight the mechanisms involved. The aim of this study was to describe the process of treatment disengagement and identify warning signs that foreshadow dropouts of adolescents with BPD. Method: A constructivist grounded theory method was used. This method has been favoured based on the assumption that the behaviours and decisions leading to disengagement may be better informed by the subjective experience of treatment. Thirty-three interviews were conducted to document 11 treatment trajectories with 3 groups of informants (9 adolescents with BPD 13-17 of age, 11 parents, and 13 clinicians). Results: Well before dropout occurs, different phenomena identified as “engagement complications” characterize the disengagement process. These unfold according to a three-step sequence starting with negative emotions associated with the appropriateness of treatment, the therapeutic relationship or the vicissitudes of treatment. These emotions will then generate treatment interfering attitudes that eventually evolve into openly disengaged behaviours. These complications, which may sometimes go unnoticed, punctuate the progression from treatment engagement to disengagement leading the way towards the development of a “zone of turbulence” which creates a vulnerable and unstable therapeutic process presenting risk for late dropout. Conclusion: Engagement of adolescents with BPD is neither static nor certain, but on the contrary, subject to their fluctuating perceptions. Therefore, it can never be taken for granted. Clinicians must constantly pay attention to emergent signs of engagement complications. Maintaining the engagement of adolescents with BPD should be a therapeutic objective akin to reducing symptomatology or improving psychosocial functioning, and should therefore be given the same attention.

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Adolescents reçus en urgence en psychiatrie infanto-juvénile. Qui sont-ils ? Quel est leur parcours ? Quel suivi social et/ou judiciaire ?

Cited by 16 publications

References 22 publications

Engagement Complications of Adolescents with Borderline Personality Disorder: Navigating Through a Zone of Turbulence

Engagement Complications of Adolescents with Borderline Personality Disorder: Navigating Through a Zone of Turbulence

Étude des notifications à la Maison départementale des personnes handicapées chez les enfants placés à l’Aide sociale à l’enfance dans les Bouches-du-Rhône

Engagement Complications of Adolescents with Borderline Personality Disorder: Navigating Through a Zone of Turbulence

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