Need for systematic screening for IGD in adolescent psychiatric inpatients.

Psychiatric comorbidities are frequent in adolescents with internet gaming disorder (IGD). In contrast, the proportion of IGD among adolescents hospitalized for a psychiatric disorder has not been documented yet. In addition, parental ratings of IGD could be useful for diagnosis, but very few data exist on this issue. The objectives of this study were to: (1) assess the prevalence of IGD among adolescent psychiatric inpatients, using the Ten-Item Internet Gaming Disorder Test (IGDT-10), and (2) assess the parental version developed for this study (IGDT-10-P). A total of 102 patients, aged from 12 to 17 years old, were included from four psychiatric units of the French region Auvergne-Rhône-Alpes, during a 6-month inclusion period. Adolescents completed the IGDT-10 while one of their parents completed the IGDT-10-P. The inclusion rate among the eligible population was 57.95%. The prevalence of IGD in the sample, based on the IGDT-10 and IGDT-10-P, was 6.00% and 12.79%, respectively. Psychometric features of the IGDT-10-P indicated excellent internal consistency, a good model fit to the one factor model in confirmatory factor analysis, a strong correlation with gaming time, and a moderate correlation with the IGDT-10. Our results support the need for a systematic screening of IGD among adolescents hospitalized for a psychiatric disorder. Future studies should aim to confirm and explain the prevalence gap between self- and parent-reported criteria.

[Suicide attempts of 48 children aged 6-12 years]. / Tentatives de suicide chez 48 enfants âgés de 6 à 12ans.

AIM: Research is limited on suicide attempts in children under 13 years of age. The objective of this study was to provide an in-depth description of this population. MATERIALS AND METHODS: The present study is both retrospective and descriptive. Data were collected retrospectively from a file containing the causes for hospitalization of each child admitted into the Department of Child Psychiatry at the hôpital Femme-Mère-Enfant (hospices civils de Lyon). We included all patients under 13 years of age who were hospitalized for a suicide attempt between 2008 and 2011. The methods used to collect the medical records consisted in using a form made up of four major parts: suicide attempts, social environment, medical history, and therapy. RESULTS: The 26 girls and 22 boys included had a mean age of 11.52 years. The boys were younger than the girls (P=0.047) and their parents were usually separated (P=0.034). The boys used more violent means to commit suicide in comparison to the girls (P=0.048). On average, children using violent means were younger (P=0.013). Boys underwent more psychotherapy (P=0.027) and were prescribed more psychotropic medication in comparison to girls (P=0.051). Adjustment disorders (37.5%) and depression (27%) were the two main diagnoses for hospitalization. They were hospitalized on average (±standard deviation) 9.6 days (±10 days). Psychotherapy was organized when leaving the hospital (98%) with legal measures (8.3%), change of residence (12.5%), and prescription of psychotropic drugs (37.5%). None had physical complications. DISCUSSION: In children under 13 years of age, attempted suicide was more frequent in girls than boys. However, the sample included 18 girls and nine boys who were 12 years old (sex ratio of 12-year-olds, 0.5). There were more boys (16 boys/eight girls) in the children under 12 (sex ratio of 8- to 11-year-olds, 1.6). Children under 11 used more violent means (P=0.01). The literature also reports that more violent means lead to a greater risk of death by suicide. Consequently, suicidal behavior in children under 11 years of age is closer to a behavior of a person who has committed suicide than an adolescent attempting suicide. As a result of the sex ratio and non-violent means, 12-year-old children's behavior can be considered like that of adolescents. One factor that could explain children's attempted suicide is family cohesion. The children in this study were most often from broken families and had a difficult relationship with their parents. From 1981 to 1985, more than 50% of children who consulted for their first suicide attempt were not hospitalized. Now hospitalization is recommended for all children who consult for attempted suicide. They are hospitalized on average 8.9-9 days. Individual psychotherapy is systematic. The main difference between the treatments for adolescents and children is the importance of the social worker who will require legal measures or changing residences when necessary. CONCLUSION: The sex ratio in 6- to 12-year-olds attempting suicide is higher than the sex ratio in adolescents attempting suicides. Insecure attachment was found in all families in this sample. This population is particularly at risk knowing that in adulthood, the risk of death by suicide is higher when there is a background of attempted suicide by violent methods. These children should always be hospitalized for a psychological and socioenvironmental evaluation.

[Some reflexions about double blind]. / Quelques réflexions sur le double insu.

LITERATURE FINDINGS: Randomized, double blind, placebo-controlled clinical trials are currently the best means of demonstrating the clinical effectiveness of drugs. The double blind procedure, when ethically and technically feasible, is a necessary condition for validating results and for causal attribution of the observed difference between the two groups to the tested drug's pharmacological effect. COMMENTS: In practice, however, it appears that patients and independent investigators can guess who receives the drug and who receives a placebo through side effects, which are usually more frequent in patients receiving the drug. This phenomenon effectively "breaks the blind" and represents as such a major methodological bias, which cannot be avoided as it is inseparable of the drug's effect. CONCLUSION: The impact of this "unavoidable" double blind breach nevertheless remains unclear. While it can reasonably be assumed that it may modify subjective symptoms such as anxiety or pain through suggestion, its influence on objective criteria remains to be demonstrated.