Bodily expression of psychological distress in adolescents: a qualitative study.

INTRODUCTION: The bodily expression of psychological disorders is one of the leading motives for consultations in adolescent medicine. The diagnostic entity corresponding to DSM-5 "Somatic symptom and related disorders" is sparsely used in the English-language literature, especially for adolescents. Qualitative studies on this topic mostly concern the experiences of healthcare professionals. This study seeks to explore the experience of adolescents expressing psychological distress through their body. METHODS: This exploratory research took place in a Paris hospital department of adolescent medicine. Our sampling method was purposive. For inclusion, patients had to be aged 11-24 years, with a "somatic symptom disorder" meeting the DSM-5 criteria. Semi-directive interviews were proposed with visual narration inspired by photoelicitation. Thematic analysis allowed us to explore the data with an inductive approach. RESULTS: Thirty adolescents were interviewed; they were 14-22 years old and mostly had somatic symptom or functional neurological disorders. Three principal themes emerged from our analysis of the interview contents: the personal, including bodily, experience of the disorder, the experience of relationships, and the question of what is visible through the body. CONCLUSION: This research allowed us to discuss the reversal of generations, the function of the DSM-5 diagnosis, illuminated by sociology, and finally, cultural pathways. It shows the importance of recognizing the reality of the adolescents' bodily feelings, reassuring them by ruling out serious causes, and supporting their search for meaning. It is important to think about a specific framework of family therapy that can make effective use of this experience of the reversal of generations.

[Temporality of individual psychotherapy in adolescents with anorexia nervosa]. / Temporalité de la psychothérapie individuelle chez les adolescents souffrant d'anorexie mentale.

The management of patients suffering from anorexia nervosa involves the intervention of several professionals in a complementary manner. Within the framework of the multidisciplinary approach (somatic, psychiatric, dietetic, family, etc.), several factors must be taken into account in the clinical evolution to establish the indication of an individual psychotherapy in the most efficient way possible.

Health-related quality of life of patients with hypothalamic-pituitary-adrenal axis dysregulations: a cohort study.

OBJECTIVE: Health-related quality of life (HrQoL) is increasingly considered to be an important outcome of care for hypothalamic-pituitary-adrenal (HPA) axis dysregulation. The objective of this study was to assess the influence of type of HPA axis dysregulation and cortisol status on HrQOL and its evolution with time and treatment. DESIGN: Prospective cohort study. METHODS: Between September 2007 and April 2014, HrQoL questionnaires were administered during routine management to all patients with HPA axis dysregulation hospitalized in a single department, and this was repeated after 6- 12-, 24- and 36-month during standard follow-up. The Medical Outcomes Study 36-item short-form health survey (SF-36) and the General Health Questionnaire 12 (GHQ-12) were used simultaneously, with a common time schedule to measure the impact of HPA axis dysregulation on HrQoL. Multivariate mixed linear regression models were constructed to adjust for potential confounders. RESULTS: 343 patients (206 with Cushing's syndrome of pituitary origin, 91 with Cushing's syndrome of adrenal origin and 46 with Addison's disease) responded to the questionnaires. Overall, HrQoL scores were well below population values. Cushing syndrome of pituitary origin was associated with worse HrQoL, especially in physical dimensions. More than half of the patients, of all diagnoses and cortisol status, had psychological distress requiring attention according to the GHQ-12. Hypercortisolism had the greatest negative influence on HrQoL. CONCLUSIONS: HRQoL appears significantly altered by all forms of HPA axis dysregulation, and most substantially and broadly by Cushing's syndrome, notably during periods of hypercortisolism. These effects on HRQoL deserve further consideration both in clinical practice and research.

[Glucocorticoid treatments and adrenal function]. / Corticothérapie et fonction surrénale.

Glucocorticoid treatments inhibit adrenal axis at the hypothalamo-pituitary level. This inhibition decreases ACTH plasma levels, leading to unpredictable secondary adrenal insufficiency after glucocorticoids withdrawal. Almost half of the patients will present with corticotrop axis suppression after long term glucocorticoid treatment. Glucocorticoid dose and duration of treatment might be linked to hypothalamic-pituitary-adrenal suppression; but some not yet clearly identified individual parameters are also important. After long-term glucocorticoid treatment, in order to reduce the risk of clinical sign of adrenal deficiency, the glucocorticoid dose is progressively decreased. When the daily glucocorticoid dose is tapered below 5 mg/day of equivalent prednisone, a hydrocortisone substitutive treatment can be started. Before discontinuation of the treatment the full recovery of the corticotrop axis could be assayed by corticotropin stimulation test.