The "choking game": a new craze among Brazilian children and young people. Psychophysiological, behavioral and epidemiological characteristics of 'asphyxial games'. / "Brincadeira do desmaio": uma nova moda mortal entre crianças e adolescentes. Características psicofisiológicas, comportamentais e epidemiologia dos 'jogos de asfixia'.

The 'choking game' is a risk-taking behavior that has spread quickly among children and young people, causing dependence, accidents and even death, including in Brazil. These activities are performed in order to experience fleeting euphoric sensations, attracting numerous participants through the thousands of videos posted on YouTube. The problem of 'asphyxial games' can be observed in the Brazilian digital media, although there is a lack of scientific studies. Through a systematic review of the literature and complementary material, this paper aims to address the 'asphyxial games', warning about the psychophysiological and behavioral effects of these practices, while also presenting international epidemiological data. Sharing this information in academic circles is extremely important given the need to acquire more knowledge on the topic, train professionals and propose preventive measures that raise awareness among children and young people of the potential danger of voluntary fainting. It is equally important to raise awareness among parents and teachers so they can identify the warning signs that children may be engaging in these practices. And finally, it is also necessary to request government support to control exposure to videos that encourage the behavior.

"Brincadeira do desmaio": uma nova moda mortal entre crianças e adolescentes. Características psicofisiológicas, comportamentais e epidemiologia dos 'jogos de asfixia' / The "choking game": a new craze among Brazilian children and young people. Psychophysiological, behavioral and epidemiological characteristics of 'asphyxial games'

Resumo As 'brincadeiras do desmaio' são comportamentos de risco que têm se difundido rapidamente entre crianças e jovens, provocando dependência, acidentes e mesmo mortes, inclusive no Brasil. Estas atividades são realizadas para vivenciarem sensações eufóricas e fugazes, atraindo grande número de adeptos por meio de milhares de vídeos postados no YouTube. A problemática dos 'jogos de asfixia' é observada nas mídias digitais brasileiras, mas carece de estudos científicos. Por meio de revisão sistemática da literatura e de bibliografia complementar, este trabalho objetiva discorrer sobre os 'jogos de asfixia', alertando aos aspectos psicofisiológicos e comportamentais, aos riscos potenciais destas práticas e, também, apresentar dados epidemiológicos internacionais. Compartilhar essas informações no meio acadêmico é de extrema importância dada a necessidade de maiores conhecimentos sobre o tema, de realizar capacitação de profissionais e de propor medidas preventivas que sensibilizem crianças e jovens ao perigo potencial dos desmaios voluntários. Sensibilizar igualmente os pais e professores a atentarem aos sinais decorrentes destas práticas. É também relevante a busca de apoio dos governantes para o controle da divulgação de vídeos incitativos.

Abstract The 'choking game' is a risk-taking behavior that has spread quickly among children and young people, causing dependence, accidents and even death, including in Brazil. These activities are performed in order to experience fleeting euphoric sensations, attracting numerous participants through the thousands of videos posted on YouTube. The problem of 'asphyxial games' can be observed in the Brazilian digital media, although there is a lack of scientific studies. Through a systematic review of the literature and complementary material, this paper aims to address the 'asphyxial games', warning about the psychophysiological and behavioral effects of these practices, while also presenting international epidemiological data. Sharing this information in academic circles is extremely important given the need to acquire more knowledge on the topic, train professionals and propose preventive measures that raise awareness among children and young people of the potential danger of voluntary fainting. It is equally important to raise awareness among parents and teachers so they can identify the warning signs that children may be engaging in these practices. And finally, it is also necessary to request government support to control exposure to videos that encourage the behavior.

Forensic mental health assessment in France: recommendations for quality improvement.

The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called "experts" in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods.

The causal representation of outpatients with Crohn's disease: is there a link between psychological distress and clinical disease activity?

OBJECTIVES: Because of the fluctuating and occasional character of Crohn's disease (CD), patients have to cope with a changeable condition of health. Personal perceived control is known to be an important element of adaptation to their medical condition. The objectives of this work are to determine if perceived personal control is predictive of the clinical activity of the disease and of psychological distress (depression, anxiety). METHODS: The Hospital Anxiety Depression Scale (HADS), the causal dimension scale and the Clinical Global Impression (CGI; assessing perceived severity) were administered to 160 patients affected by Crohn's disease. Indicators of inflammation (CRP), disease duration and clinical activity of the disease were also asessed. RESULTS: Globally, CD patients perceive their disease as being personally neither controllable nor uncontrollable. Whereas psychological distress is significantly higher when the disease is active, the relationship between the variables appears complex. The feeling of personal control is explained by the clinical activity of the disease (p=.0001) and by the perception that CD is unstable (p<.00001) and globally impacts the life of patients (p=.001). Nevertheless perception of personal control does not explain the clinical activity of the disease. Finally, psychological distress is explained by the perception that the medical team is unable to control the disease (p=.00001) and by the global consequences of the disease on life (p<.005). CONCLUSIONS: Psychological treatments should take these dimensions into account so as to improve the well-being and medical conditions of patients.

Study of the correlation between psychiatric and psychological diagnoses in sample offenders.

This study deals with the frequency with which expert psychiatrists and psychologists make structural or nosographic diagnoses within the context of expert assessment. Thus, the rates of concordance between psychiatrists and psychologists in both types of diagnoses will be assessed. To do so, the level of inter-observer agreement on diagnoses between 1990 and 2003 was studied retrospectively in France through psychiatric and psychological assessments of 505 male offenders. The assessment of the correlation rates was carried out using the Kappa coefficient. The results show a range of 0.55 to 0.71 in inter-observer (psychiatrists vs psychologists) agreement for structural diagnoses, and 0.51 to 0.89 for nosographic diagnoses. In addition, a marked correlation between psychiatrists and psychologists may be noted regarding abstention in both structural (k=66) and nosographic (k=73) diagnoses. In fact, recommendations are made for improvement in the consistency of offender assessment in the psycho-legal French context.

A Rorschach stability study in a nonpatient adult sample.

The objective of this study was to provide new primary data on Rorschach Comprehensive System stability levels. To achieve this, we tested 75 French nonpatient adults twice on the Rorschach with a 3-month interval between the tests. Interrater reliability was in the excellent range for most of the variables studied. The overall stability level in a selected set of previously studied variables was below expectations (median r = .53). Personality, cognitive or self/relational variables yielded higher test-retest correlations than emotional and coping variables. Moderators of stability could be identified: (a) overall level of Task Engagement (TE) in F, m, FM + m, a, FC, Sum C', Sum V, Sum Shd, Fr + rF, INC + FAB, COP, es, Adj es, EGO, and Blends; (b) variations in TE in F, FM, and p; (c) state distress in Zd, m, FM + m, a, C, CF + C, WSumC, FD, and es; (d) variables derived from the number of responses impacted stability in P, Zf, m, FC, CF + C, Sum C', Sum V, MOR, EA, es, and Blends. These results provide further support for the reliability of several measures. Examiner effects as an influence on productivity and TE were identified as an important area for future research.